Private Health Insurance and Plans Information Exchange Standard (TISS)

Due to the absence of standards and the complexity of information exchanges among private health insurers and private insurance healthcare providers, in parallel to limited investments in Information Technology, the National Regulatory Agency for Private Health Insurance and Plans (ANS) resolved to establish the Private Health Insurance and Plans Information Exchange Standard (TISS). Developed on the basis of Brazil and international standards, it is designed to enhance healthcare quality while rationalizing costs and making the best possible use of existing resources. The TISS Standard is grounded on the assumption of the interoperability of the health information systems required by the Ministry of Health. The TISS Standard was established in 2007, as a mandatory parameter for supplementary healthcare information exchanges at the medical and administrative levels among private healthcare plan operators, healthcare service providers, private health insurance plan beneficiaries and the ANS. Private health insurers rated as benefits management organizations are not required to adopt the TISS Standard.


The TISS Standard is organized into four components:

1 - Content and structure

The content and structure standard establish the healthcare and administrative information to be exchanged among private health insurers, private insurance healthcare providers and private health insurance beneficiaries.

2 - Representation of Health-Related Concepts

The standard for the representation of health-related concepts establishes a set of terminologies, codes and descriptions for use in the content and structure standard.

3 - Safety and Privacy

The safety and privacy standard establishes the minimum requirements for the administrative, technical and physical protection needed to ensure the confidentiality of the information.

4 - Communications

The communications standard establishes communication methods among information systems, as well as electronic transactions.


Supplementary Healthcare Unified Terminology

On the private healthcare insurance market, there have always been many terminologies coding and describing health-related procedures and events. During the implementation of the Private Health Insurance and Plans Information Exchange Standard (TISS), a clear need arose for the adoption of a common clinical terminology by the entire supplementary healthcare sector. The Common Private Health Insurance and Plans Terminology is thus the outcome of the efforts of the ANS, working in close cooperation with the Private Health Insurance and Plans Information Standardization Committee members, pursuing the aim of establishing this standard terminology in the sector.


Supplementary Healthcare Information Standardization Committee

The Private Health Insurance and Plans Information Standardization Committee is a Working Group set up in order:

  • To present proposals to the ANS on fine-tuning the TISS Standard;
  • To review the terms constituting the representation component of health-related concepts and analyze applications for inclusions in the Private Health Insurance and Unified Terminology (TUSS):
    • To promote the dissemination and oversee the adoption of the TISS Standard;
    • To analyze the private health insurance and information systems coordinated by the ANS; and
    • This Committee consists of representatives of the ANS, the Ministry of Health, private healthcare insurers, private insurance healthcare providers, teaching and research institutions and entities representing the users of private health plans.

The purposes of this Committee are:

1

to present proposals to the ANS on fine-tuning the TISS Standard;

2

to review the terms constituting the representation component of health-related concepts and analyze applications for inclusions in the Supplementary Healthcare Unified Terminology (TUSS);

3

to promote the dissemination and oversee the adoption of the TISS Standard;

4

to analyze the supplementary healthcare information systems coordinated by the ANS, in order to fine-tune the TISS Standard and

5

to promote, encourage and recommend studies of health-related information and communication technology.

This Committee consists of representatives of the ANS, the Ministry of Health, private healthcare insurance plan Operators, private healthcare service providers, teaching and research institutions and entities representing the users of private healthcare insurance plans.

In order to perform its activities, this Committee may be assisted by guest members, selected from among scientists and technical experts with expertise n this field, as well as other entities, and may also set up Technical Councils to prepare studies and expert opinions on specific themes.


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ANS - Agência Nacional de Saúde Suplementar - Av. Augusto Severo, 84 - Glória Rio de Janeiro/RJ - Brasil - CEP: 20021-040