How do I, a doctor, accredit me to a health plan?

How do I, a doctor, accredit me to a health plan?

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Be accredited to an operator of health plans can be a good choice for a career, but it is necessary to exercise caution

There are several operators of health plans to which doctors can be accredited, and this association can be a good choice for professional career. However, it is always necessary to be cautious, especially when dealing with large companies in the industry, which do not always respect the agreed terms between doctor and health plan.

But what is accreditation? The concept is quite simple. A doctor if accredits a health plan, and insured by this plan may use their covenants to be met by the clinic or at accredited professional. The doctor also is on the company’s catalog that offers health insurance, thus gaining visibility and possibility of getting younger patients.

But there are also cons. To be accredited to a health plan, the doctor submits to make inquiries for a very low price compared to what would be would meet in a particular way to patients. On the one hand, a doctor gets patients to join a health plan, on the other, will have to meet more and more for a profitable income. There is a contract and requirements to which the professional will have to follow to fit to the company that is accredited, and these specifications vary from carrier to carrier.

Especially doctors in early career have the custom to associate with health plans to get more patients and has build an image as a professional in order to retain your calls. However, it is good to take care of all the paperwork so that the doctor does not become a hostage of the health plan. The professionals have the right to accredit how many plans they wish, so operators are prohibited from signing exclusive contracts with doctors.

 Accreditation to health plan

To become certified to a health plan, the professional should report directly to the plane’s operator, and follow your requirements. For the doctor, as individuals, they are usually required the following documents: Register of Constituent Securities (CCM) and service tax (ISS); National Register of Health Facilities (CNES); Certificate updated in CRM; License updated health surveillance; Permit date of operation; curriculum; University Degree; CPF and responsible technical specialist title; the technical manager CRM; bank statement and data from the point of care.

SUS, although public, it is also considered a health plan. And like any public good, its release of funds happens through notices to which the professional competes. To be contemplated by the notice, which usually has duration of two years, the doctor is considered a public official, even if you answer in your own office. It is mandatory to supply at least 30 consultations or tests per month.


On the one hand, be accredited to a health plan may seem easy and simple, on the other, receive the consultations can be a bureaucratic and complicated process. It is recommended to always have on hand (and mind) the accreditation agreement to avoid problems.

Performed by each query or procedure, the doctor fills a TISS Guide. At the end of the month, professionals cadastram all tabs and their details on a system on the Internet. That done, it is time to print and send the guides to the operators, who are responsible to do the analysis and the payment of the invoice.

There is also the possibility of the operator gloss, for some reason, some of the guides. Gloss means not accept the legitimacy of the procedure performed by the professional, failing to pay him for the service. The doctor has the possibility to appeal the disallowance, correct what is asked and require payment again.

Regardless of your decision is important that the health professional sees his office as an enterprise that need strategic attention. You have to invest some of your time to plan actions for dissemination of practice and increase the quality of care.

Invest in a good management can impact on results rather than the office offers you every month. So it is important to start thinking about investing in technology to centralize all office processes – administrative, financial and strategic – in one place: one management software and marketing for offices .

In  iMedicina  we offer this possibility! Learn about our proposed visit to  our website  and better understand how to computerize your office and attract new patients!

To delve further into the matter and find other tips for the financial management of his office, take a look at the items we prepared:

  • What you lose without an accurate control of the office’s finances?
  • Find out why your office needs URGENT a financial forecast
  • Complete Guide to improve the financial management of the office
  • Best practices in the financial management of the office

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