Digitally Attesting
Sophia offers two ways to electronically prove a treatment to the mutuality: eAttest and eFact. Almost every new user mixes these two up the first time. This guide explains, completely from scratch, what each one is, when you use which, and how to actually use them, step by step.
First, the Basic Idea: Why Does This Exist?
When you treat a patient, the mutuality partly or fully covers the cost. To be allowed to do this, the mutuality needs proof that the treatment actually took place. That proof is called an attestation.
In the past, you printed this attestation on paper. With Sophia, this now happens digitally, through eHealth: the secure system healthcare providers and mutualities use to communicate with each other.
There are two digital ways to do this, depending on who pays you:
- eAttest: the patient pays you the full amount themselves. Sophia just sends the proof to the mutuality, so the patient doesn't have to do this themselves.
- eFact: the patient doesn't pay you the full amount, only the small remaining part, the copayment. The mutuality pays the rest directly to you. This is called a third party payment arrangement.
Which One Do You Need?
Ask yourself this one question: does the patient pay you the full amount, or only the copayment?
- Full amount → use eAttest.
- Only copayment → use eFact.
Still unsure? For most patients, without a special arrangement, you use eAttest. You only use eFact when you've agreed on a third party payment arrangement with the patient beforehand, or for legal reasons such as increased reimbursement status.
eAttest, Step by Step
Step 1: open the appointment
Go to the Calendar, and click today's appointment with the patient you want to attest.
Step 2: click "Attest"
On the appointment itself you see a button Attest. Click it to open the attestation window.
Step 3: check the eAgreement reference
Does this patient have an ongoing eAgreement (see Requesting an eAgreement)? Then Sophia usually selects the correct reference automatically. Double check this before continuing: is the right treatment selected?
Step 4: optionally add earlier appointments
Does the patient have earlier appointments you haven't attested yet? Add them here, so everything is sent together in one go, instead of separately.
Step 5: send it
Click the eAttest button at the bottom of the window.
What Happens Next?
- Did sending succeed? Then you get an attestation number. That attestation automatically appears in the overview on the Attestations tab. That's all you need to do: the patient doesn't have to take any action themselves.
- Did it fail? Sophia doesn't show a separate success or failure message, only whether an attestation number appears or not. Doesn't a number appear? Then there's usually a problem with your eHealth certificate. See Linking the eHealth Certificate to check this.
eFact, Step by Step
eFact works completely differently from eAttest: here you don't request reimbursement for one patient, but for several patients at once, bundled per mutuality, from a separate screen, so not from the appointment itself.
Step 1: open the eFact screen
Go to eFact in the main menu, at the top of Sophia.
Step 2: start a new request
Click Create eFact.
Step 3: choose the period
Choose the period you want to request reimbursement for, for example the past month.
Step 4: filter if you want
Tick Only patients with third party payment arrangement if you only want to see these patients. This is optional, but makes the list clearer.
Step 5: choose one mutuality
Choose one specific mutuality from the list. Sophia then shows only the appointments of patients insured with that one mutuality: you can't combine mutualities within the same eFact.
Step 6: choose which appointments to include
Sophia shows a table with every eligible appointment. Tick, row by row, which ones you actually want to include.
TIP
Does an appointment have an error, for example a missing piece of data? Then Sophia automatically unticks that row, so you don't accidentally include it.
Step 7: fill in the invoice number
Give this eFact its own invoice number.
Step 8: send it
Click Create eFact to submit the request for good.
WARNING
You can only create one eFact per mutuality per day. Want to send a second request for the same mutuality anyway? Then you have to wait until the next day. Missing something essential in your profile, such as your IBAN, BIC, phone number, or company number? Then you can't send an eFact at all: fill this in first at Profile.
Following Up on Your eFact's Status
After sending, you'll find your eFact in the overview, with a status:
- Sent: just submitted, no response from the mutuality yet.
- In Treatment: the mutuality is still processing the request.
- Accepted: fully approved. The mutuality will pay soon.
- Partially Approved: part of the appointments accepted, another part rejected.
- Rejected or Refused: the mutuality turned down the request.
Click Fetch eFact messages to request the latest updates from the mutuality.
What If the Mutuality (Partially) Refuses?
- Open the eFact's details.
- Find the appointment that was rejected.
- Read the reason reported by the mutuality, for example an incorrect nomenclature code.
- Fix the issue, for example on the prescription or the appointment itself.
- Resubmit the affected appointment through a new eFact.
TIP
Sophia doesn't have a button to resend only the rejected line: you always have to do this through a new eFact.
Common Mistakes
- Using eAttest for a patient with a third party payment arrangement: the patient then incorrectly pays the full amount. Use eFact instead.
- Forgetting that eFact only works once per mutuality per day: you have to wait until the next day for a second request to the same mutuality.
- An expired eHealth certificate: this makes both eAttest and eFact fail, often without a clear message.
- Thinking an eFact gets automatically resent after a refusal: you always have to do this yourself, manually.
TIP
For the full explanation per module, including the background, see the Billing Modules guide.