Operational guide reviewed on 4 August 2026.
Goal: give the patient a complete, traceable claim that matches the clinical record.
Claim control matrix
| Control | Required evidence | Risk |
|---|---|---|
| Beneficiary | Name, registration, active rights, scheme | Unidentifiable claim |
| Practitioner | Signature, stamp, INPE, tax ID and ICE | Administrative return |
| Procedure | Code, coefficient, date and amount | TNR cannot be established |
| Tooth | Number and matching dental chart | Clinical inconsistency |
| Root canal | Before-and-after radiographs | Missing medical evidence |
| Surgical extraction | Recent pre-operative radiograph | Claim cannot be assessed |
| Prosthesis/orthodontics | Estimate and prior approval where required | Coverage may be refused |
| Deadline | CNOPS submission within 60 days | Late claim |
Professional workflow
- the clinician validates the tooth and procedure;
- the front desk verifies identity and amounts;
- radiographs are linked to the correct procedure;
- a dated PDF copy is given to the patient;
- submission date and tracking reference are recorded.