Follow another complete article written by SAUDI and find out below the ANS deadlines, their importance and how to effectively comply with them.

Everyone likes quality service, right? With this in mind, the National Supplementary Health Administration published Normative Resolution No. 395, which aims to make the services provided by health plan operators more qualified and with greater agility in service.

According to this standard, healthcare operators must offer in-person service units in the regions where they are largest. In addition, telephone support is required on weekdays. However, due to the pandemic caused by the coronavirus, ANS is trying to contain the risk of contamination, helping to prioritize cases of COVID-19. Furthermore, there are no restrictions on beneficiary services.

However, for cases that cannot be postponed or continued, as the current focus is on treating serious cases of Covid-19, the maximum service period for consultation, examination, treatment and surgery has been extended.

Want to know more? Check out this article written by SAUDI about ANS deadlines and the importance of meeting them!

The reasons why you must meet ANS deadlines

With the new standards, health plan operators are looking for ways to improve their services to beneficiaries every day.

According to the Reclame Aqui website, service has been very unstable and there are many complaints on the website every day. Therefore, it is very important that operators meet ANS deadlines responsibly.

The company is obliged to provide in-person and telephone support and send written information to the beneficiary within 24 hours.

Large and medium-sized operators must also install face-to-face service units during business hours, at least in the locations or capitals where their services are most concentrated.

Telephone service must also be provided during working days and hours.

Additionally, a service contract must be provided to the user so that they can track the request.

For health plan operators that do not meet the ANS deadline, fines for emergencies range from R$ 80,000 to R$ 100,000.

In case of further non-compliance with the rules, the company may suspend the sale of the services provided.

In some cases, there may also be a special system for technical guidance or dismissal of directors.

Discover the Deadlines defined by ANS

As mentioned above, the standard defines the deadline within which the response must meet the ANS definition.

To do this, operators must understand the rules and not run the risk of any punishment. However, the standard still has an appendix.

If the maximum ANS period is less than five days, the response time will be the same as compliance with the normative resolution.

Check the deadlines according to the following procedures:

• Urgent and emergency situations: respond immediately;
• High complexity (APAC): Response in 21 working days;
• Elective hospitalization: response within 21 working days;
• Other procedures or services: 5 working days for response;
• Basic consultation - pediatrics, internal medicine, general surgery, obstetrics and gynecology: 07 working days;
• Day hospital care: respond within 10 days;
• Other outpatient services: 10 working days;
• Diagnostic service in an outpatient clinical analysis laboratory: 03 days;
• Procedures and consultations in a dental office/clinic: service within 7 days;
• Consultation with a physiotherapist, speech therapist, nutritionist, psychologist and occupational therapist: response within 10 business days;
• Other professional consultations: 14 working days for response.

More details about ANS deadlines

Through the information system, ANS will monitor the sale of all suspended services. Furthermore, if there are illegal registrations, the company can file a complaint.

If the operator is found to be selling the suspended plan, they will be fined R$ 250,000. Except for the period of administrative measures stipulated in the regulation.

However, health plan operators that have suspended a service as punishment for failing to meet the ANS deadline will be able to register a new product, which will be duly monitored by the agency. The suspended plan can be resold after ANS evaluation and the operator provides improved services.

If other services are suspended for the same reason, technical guidelines and management measures may be taken, and the company director may be removed.

The criteria for considering suspension of the plan are the number of complaints related to service and the average number of beneficiaries in the evaluation period.

Using technology to comply with ANS

The new technology is very effective and can contribute to operators who know how to use it. Digital transformation is a necessary process that can bring countless benefits to companies that implement it.

A recruitment system that automates activities, integrates processes, improves demand agility and brings more practicality to beneficiaries, could be the solution for operators to meet ANS deadlines.

SAUDI is a system designed to maintain the “financial health” of Supplementary Health Plan Operators.

Our software automates the process of audit of accounts of medical service providers, enabling a clear vision for both sides (operators x service providers) and a significant reduction in unnecessary costs.

Acting throughout the entire process, from requesting authorization for medical procedures from the network of providers to their respective release for payment, SAUDI's objective is for companies in the area to become healthier and achieve better results through better management of your assistance costs.

The results are surprising in the first few months of use! Contact with our experts and discover all the customized solutions according to the needs of your institution!