In the Brazilian supplementary health scenario, the relationship between health plan operators and service providers is still often marked by noise, divergences in auditing processes and recurring disallowances. However, there is a proven way to transform this scenario: transparency. Providers that invest in automated systems and transparent practices not only strengthen their relationships with hospitals, clinics and laboratories, but also increase efficiency, reduce costs and improve the quality of care provided to beneficiaries.

In this article, we'll understand how transparency in the processes between operators and providers can generate real value, and how systems such as the SAUDI - a national reference in automated medical auditing - are revolutionizing the way this sector operates.

 

The importance of transparency in supplementary health

Private healthcare deals daily with thousands of authorizations, medical notes, OPME (Orthotics, Prosthetics and Special Materials) quotations, disallowances and reimbursements. Each stage carries with it the risk of human error, subjectivity in analysis and a lack of uniformity in the criteria used.

This lack of standardization leaves room for conflict, rework, unnecessary costs and, ultimately, damages the patient experience.

By adopting practices and tools that guarantee transparency and traceability, operators can achieve this:

• Reduce disallowances and rework with providers;
• Increase financial predictability;
• Standardize conduct;
• Optimize auditors' time;
• Create a solid database for management and compliance;
• Strengthen trust with the accredited network.

 

Where technology comes in: the role of automated medical auditing

Process automation in healthcare is no longer a trend - it's a necessity. Systems like SAUDI offer state-of-the-art technology to automate the auditing of medical bills, guaranteeing total transparency for both parties: operators and providers.

With the use of artificial intelligence, machine learning and a rule base that is up-to-date with ANS standards, SAUDI makes it possible:

• Automatic authorization of procedures based on technical and regulatory criteria;
• Real-time auditing of accounts;
• Monitoring OPMEs from request to delivery;
• Cost control with automatic alerts;
• Direct communication channel with providers;
• Mobile interface for beneficiary monitoring;
• Analytical reports with insights for management.

 

Reducing disallowances: a direct impact on results

Medical disallowances are one of the main sources of friction between operators and providers. In most cases, they are caused by simple faults: missing documents, incorrectly filled out forms, coding errors, etc.

Automated auditing with SAUDI gets to the root of the problem. With prior validation of documents, automatic checking of TUSS and CBHPMWith its configurable eligibility criteria, the system drastically reduces the rate of disallowances - which means savings and an improvement in the relationship with providers.

 

Process efficiency: from customer service to OPME quotations

The beneficiary and provider journey within the operator's system must be fluid. SAUDI offers a complete ecosystem to manage all touchpoints efficiently, including:

• Centralized requests and authorizations;
• Mobile app for real-time monitoring;
• Integration with the main electronic medical records and hospital systems;
• OPME management with a panel for quotation, approval and traceability;
• Auditing based on clear, parameterized rules that are fair to all sides.

 

More transparency = less judicialization

Another direct benefit of adopting transparent practices is the reduction of legal risk. By keeping all records accessible, well-documented and backed up by technical criteria, the operator reduces the risk of lawsuits for denial of coverage, conflicts over disallowances and accusations of unethical conduct.

This not only protects the operator legally, but also improves its institutional reputation in the eyes of the market and regulators.

 

SAUDI's difference in the market

Recognized as the country's most awarded medical auditing systemSAUDI has been adopted by dozens of operators of different sizes and regions in Brazil. Its differential lies in uniting:

• State-of-the-art technology with ease of use;
• Specialized technical support in health;
• Constant updating based on ANS standards;
• Rapid deployment and adaptable to the size of the operator;
• Performance reports with actionable indicators.

 

Success story: operator reduces 42% of disallowances in 6 months

A medium-sized operator in southeastern Brazil implemented SAUDI to automate its medical audit and automate the entire process. In just 6 months, the disallowance rate fell to practically 0, costs fell by 20%, and provider satisfaction increased significantly, according to the care costs supervisor interviewed by the Saudi Blog team. Check out this success story!

This is just one of our success stories that show the positive impact of technology and transparency on health.

 

The future of healthcare management is transparent and automated

Operator managers and medical bill analysts who want to reduce costs, improve the relationship with the provider network and gain operational efficiency need to take a serious look at transparency as a strategic pillar.

Automating the auditing of medical bills with SAUDI is a decisive step towards this. With technology, security and clarity in processes, operators become more competitive, reliable and focused on patient well-being.

 

Want to know how SAUDI can transform your operation?

Schedule a free demo and see in practice how automated medical auditing can take your company to the next level.