What TISS is and why it is essential for hospitals

Every exchange of information between a hospital and a health plan (from the authorization request to the denial appeal) must follow a technical standard defined by the ANS (Brazil’s National Supplementary Health Agency): TISS, which stands for Troca de Informação em Saúde Suplementar (Supplementary Health Information Exchange). Without compliance with this standard, forms are rejected, claims are denied automatically and billing is compromised before it even reaches the payer’s auditor.

TISS is not just a regulatory requirement. It structures the financial and care communication process between providers and payers, and defines the submission formats, procedure codes and validation rules for the information transmitted. Understanding how it works is a basic condition for any manager who wants to reduce billing failures and protect the hospital’s revenue.

What TISS is

TISS is the mandatory standard defined by the National Supplementary Health Agency for the electronic exchange of information between healthcare providers and private health plans. Its goal is to unify the way hospitals, clinics and physicians’ offices communicate with payers, ensuring that care, financial and administrative information follows a single format that can be validated and traced.

TISS therefore works as the industry’s communication protocol: it defines what data must be sent, in what format, in what sequence and under which validation rules. A hospital that performs a surgery needs to record and transmit all the data on that care in XML files structured according to the TISS standard, so that the payer can validate and process the payment.

What the TISS standard covers

The TISS standard covers four major dimensions of communication between providers and payers.

The first is the organizational component, which defines the administrative and business rules, including deadlines, communication flows and each party’s responsibilities.

The second is the content component, which specifies the data each transaction must contain, such as plan member identification, procedures performed, diagnosis and care team.

The third dimension is the health concept representation component, which covers the coding tables used, including the TUSS table for procedures, denial codes and diagnostic classifications. The fourth is the security and communication component, which defines the rules for secure electronic transmission of files between the parties’ systems.

Together, these four dimensions cover the entire communication cycle: from the authorization request to the claim submission, from the payment statement to filing a denial appeal.

TISS is mandatory, and noncompliance has consequences

The TISS standard was made mandatory by ANS Normative Resolution No. 305/2012, which made its use compulsory for all private health plans and their contracted providers. The rule currently in force governing the standard is Normative Resolution No. 501/2022, which consolidated the rules and defined the mechanisms for updating the standard over time.

Failing to follow the standard’s rules has direct consequences for billing. Forms sent outside the TISS format are rejected automatically by payers’ systems, with no review on the merits. Claims with coding inconsistencies generate automatic denials before they even reach the physician auditor. Regulatory protections for providers, including the right to appeal denials, apply only to those who submit their billing in the current TISS standard.

TISS 4.01: the current version of the standard

In 2025, the ANS published version 4.01 of the TISS standard, which brought updates to the content and health concept representation components. The new version expands the features for sending documents linked to forms and batches, with support for attaching files in request, authorization, billing, denial appeal and audit processes.

TISS 4.01 also improves transaction traceability mechanisms, with additional fields for identifying batches and linking documents, and reinforces compliance rules under the LGPD (Brazil’s General Data Protection Law) for the transmission of care data. Hospitals and payers have a deadline set by the ANS to adapt to the new standard, and missing it carries the same risks of form rejection and automatic denials as with previous versions.

For a full breakdown of the changes, see the article TISS 4.01: what changed and how to adapt your billing.

How TISS affects hospital billing

The quality with which TISS forms are filled out is one of the main determinants of a hospital’s denial rate. Coding errors, missing mandatory fields and incompatibilities between diagnosis and procedure are frequent causes of denials that originate directly in failures in the billing process within the TISS standard.

On the other hand, mastering the standard allows the hospital to identify inconsistencies before submission, align billing with each payer’s rules and file denial appeals with the correct documentation and on time.

Rivio applies artificial intelligence to validate 100% of TISS forms before they are submitted to the payer, automatically identifying coding errors, missing fields and inconsistencies between authorization and billing, with billing specialists supervising every stage of the process.

Frequently asked questions about TISS

What is TISS?

TISS is the mandatory standard defined by the ANS for the electronic exchange of information between healthcare providers and private health plans. It defines the submission formats, procedure codes and validation rules for the information transmitted.

Is TISS mandatory for all hospitals?

Yes. ANS Normative Resolution No. 305/2012 made the use of the TISS standard compulsory for all private health plans and their contracted providers. The rule currently in force governing the standard is Normative Resolution No. 501/2022.

What happens if a hospital does not follow the TISS standard?

Forms sent outside the TISS format are rejected automatically by payers’ systems. In addition, ANS Normative Resolution No. 363/2014 establishes that regulatory protections for providers, including the right to appeal denials, apply only to those who submit their billing in the current TISS standard.

What is the current version of TISS?

The current version is TISS 4.01, published by the ANS in 2025. It brought updates to the content and health concept representation components, expanding document submission features and reinforcing LGPD compliance rules.

How does TISS relate to the TUSS table?

The TUSS table is the procedure coding component within the TISS standard. It defines the codes that must be used to identify each procedure, test or service on the forms sent to the payer. Using codes that are incorrect or incompatible with the recorded diagnosis is one of the most common causes of automatic denials.