Initial refusals from health plan operators have increased in Brazil: in the second quarter of this year, they were 14.66%. During the same period of 2024, the percentage was 12.45%, while in 2023 the index corresponded to 9.27%, according to data from the National Association of Private Hospitals (Anahp).
The term “initial refusal” refers to the preliminary refusal or blocking of an amount presented for payment. In other words, when a healthcare provider receives an invoice, invoice or reimbursement request from a hospital, they perform an initial analysis.
If he notices an error, a lack of documents or problems in the service provided, he refuses, in whole or in part, the amount requested. However, it is possible to appeal and wait for the final verification and payment process. The refusal may affect different procedures provided by hospitals to patients, such as examinations, consultations, surgeries, hospitalizations, equipment and medications.
“The increase highlighted by Anahp reflects an environment losing balance,” assesses Vinicius Franco, co-founder of Datasigh. “From an operational perspective, we see daily at different institutions that the combination of medical inflation, stricter audits and manual processes has made the billing flow much more vulnerable. Any non-standard detail becomes a gloss. The 14.6% figure is not a deviation, it is an indication that the current model no longer supports the complexity of the industry.”
The Anahp report draws attention to the fact that the actually justified gloss at the end of the analysis in the third quarter of 2025 was only 1.97%. In other words, of the initial 14.6% of denials, only a minority go unpaid, showing that a large portion of an invoice’s value is withheld for reasons that cannot be sustained at the end of the process.
According to Franco, this situation harms the cash flow of hospitals, which have difficulty quickly receiving sums from operators – the Anahp report underlines that the average recovery time exceeds 79 days.
“Hospital cash flows shorten, obligations such as payroll, inputs and suppliers begin to compete for the same money and investments in care no longer fit into the cycle. This is a direct and immediate squeeze on operations, which gets worse month by month when there is no regularity in revenue,” explains Franco.
What can hospitals do to reduce initial refusals? For the manager, the answer lies in technology, the use of structured data and processes with clear standards. Technological solutions optimize the revenue cycle, reduce discrepancies, improve the quality of information sent and create a concrete basis that promotes more consistent agreements and reviews, in addition to making the dialogue between suppliers and operators non-subjective, he says.
Franco says different institutions have sought to improve preventative audit routines and billing digitalization to reduce the denial rate and increase operational predictability. This trend has also encouraged the adoption of integrated platforms that connect medical records, authorizations, billing and metrics in real time.
To illustrate his point of view, the manager cites a Datasigh platform, which integrates clinical, administrative and financial areas, automatically validates the rules of each operator before sending invoices and automates critical invoicing steps.
“The platform also quickly identifies glosses with the support of artificial intelligence (AI) and automation, allowing the resource to be performed at the right time and with more confidence. The result is less rework, less financial loss and more predictability,” he comments.
“The central point is to know that it is not just about speeding up the sending of invoices, but ensuring that they are correct, standardized and supported by integrated processes. The institutions that structure data, automate critical steps and connect their care and administrative areas will be precisely those that go through this cycle with the greatest investment capacity”, concludes Franco.
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