eFact
With eFact, you digitally request reimbursement from the mutuality for patients on a third party payment arrangement: the patient only pays the copayment, and the mutuality pays the rest directly to you.
TIP
This module used to be called "derdebetalers" (third party payer). It's only visible if eHealth is connected to your account, and the feature is enabled for your practice.
What Is a Third Party Payment Arrangement?
Normally, the patient pays you the full amount themselves first, and then requests reimbursement from the mutuality themselves (or automatically, via eAttest). With a third party payment arrangement, it works the other way around: the patient only pays you the copayment, the part of the fee the mutuality never reimburses anyway. You request the rest yourself, bundled for all your patients at the same mutuality, via eFact. The mutuality then pays this amount directly to you, instead of to the patient.
For patients entitled to increased reimbursement (sometimes called BIM status), this arrangement is often mandatory. For other patients, you can simply agree on this with them yourself.
TIP
Why does this arrangement exist? So a patient who's in financial difficulty never has to advance the full amount while waiting for reimbursement.
What's the Difference With eAttest?
With eAttest, you attest one patient at a time, straight from the appointment itself. With eFact, you request reimbursement for several patients at once in a single go, as long as they're insured with the same mutuality. You don't do this from an appointment, but from a separate screen.
Requesting an eFact
- Go to eFact in the main menu, and click Create eFact.
- Choose a period, and if you want, tick Only patients with third party payment arrangement.
- Choose a mutuality. Sophia then shows every appointment for all your patients insured with that mutuality.
- Tick, row by row, which appointments to include. Appointments with an error are unticked automatically.
- Fill in the invoice number, and click Create eFact.
WARNING
Sophia won't let you create more than one eFact per mutuality per day. Missing something in your profile, such as your IBAN, BIC, phone number, or company number? Fill this in first, otherwise you can't send an eFact.
Following Up on the Status
The overview shows every eFact you've submitted, along with the mutuality, the requested and accepted amount, and the status:
- Sent: just submitted.
- In Treatment: the mutuality is still processing the request.
- Accepted: fully approved.
- Partially Approved: part accepted, part rejected.
- Rejected or Refused: the mutuality turned down the request.
Click Fetch eFact messages to pull the latest updates from the mutuality.
Feedback on a Rejection
Is an eFact rejected, in whole or in part? Open its details to see exactly what went wrong. Sophia shows, per appointment, the rejection reason reported by the mutuality, for example an incorrect nomenclature number. This way you immediately know what to check.
TIP
There's currently no button to resend a rejected line directly from Sophia.
After an Accepted eFact
Does the mutuality pay its share directly to you? Then only the copayment is left for the patient. From the overview, you can create the copayment invoices for all the patients and appointments on an eFact in one go.