Requesting an eAgreement
Requesting an eAgreement is one of the most extensive forms in Sophia. There are conditions you must meet first, many fields to fill in, and a required attachment. This guide explains the entire process from scratch, in small steps.
What Is an eAgreement, Really?
For some treatments, the mutuality must give approval in advance, before the patient can be fully reimbursed. In the past, this request happened on paper, directly with RIZIV/INAMI. An eAgreement is the digital version of this request: you request approval directly from Sophia, and the approval or refusal also comes back digitally.
Before You Can Start: Two Conditions
Before you can start, Sophia first needs to establish two things about the patient. Missing either one means you can't request an eAgreement.
Condition 1: a therapeutic link
This is a digital confirmation that you're actually treating this patient.
- Does the patient have no national number filled in? Fill this in first at Basic Data.
- Has no link been found yet? Fill in the eID card number (or ISI+ card number) of the patient, and click Create therapeutic link.
Condition 2: a gender
Some pathology codes depend on gender, which is why Sophia needs this piece of data.
- Missing this? Fill it in manually at Basic Data.
- Or first fetch the eHealth Member Data: this fills in the gender automatically.
Are both conditions met? Then go to the patient's Approvals tab.
Filling In the Form, Step by Step
Step 1: open the request form
Click Request on the Approvals tab.
Step 2: choose the prescription
Choose the prescription you're requesting approval for from the list. Sophia then automatically fills in a number of fields for you, such as the number of sessions and the start date, based on this prescription.
Step 3: choose the pathology code
Sophia only shows the codes that match the chosen prescription, so you can't pick the wrong one.
Step 4: check the pre-filled fields
Check the number of sessions, the Condition appearance date, and the Agreement start date. Is something wrong here? Adjust it yourself.
Step 5: add an attachment
This is a required step: without at least one attachment, you can't continue.
- Choose the attachment type. A scan of the prescription is always required. Other possible types are: Functional report, Medical report, Physiotherapist report, CRA justification, Scoliosis protocol, Rheumatology report, Radiology protocol, and MEVS results.
- Choose the document from the list.
- Click Add attachment.
Don't have the document in Sophia yet? Upload it first via Upload new file, then repeat step 5.
WARNING
Without at least one attachment, the submit button stays disabled: you can't close the form then.
Step 6: fill in optional information
Do you need extra explanation, or is there a previous prescription that's relevant? Fill this in here. This isn't required.
Step 7: submit the request
Click the button at the bottom of the form.
TIP
Sophia doesn't show a separate success or failure message. Close the window, and check the table on the Approvals tab to see whether your request appears.
What Happens After Submitting?
This depends on the type of treatment:
- Routine treatments, such as extending an ongoing routine treatment, are usually processed automatically and immediately by RIZIV/INAMI. You'll see a green checkmark fairly quickly, meaning approved.
- Non-routine treatments, such as Fa pathology, Fb pathology, or a completely new pathological situation, are reviewed manually by the mutuality's medical advisor. This can take anywhere from a few days to several weeks. While this is happening, Sophia shows an orange clock icon, meaning "pending."
WARNING
Does RIZIV/INAMI ask for additional information, recognizable by an orange question mark, and you don't respond? After 6 months without a response, the request is automatically refused. So don't wait too long.
Understanding a Refusal
Is your request refused? Click the envelope icon next to that request: here you'll find the full, readable reason. Some common reasons:
- The prescription is older than 2 months.
- An approval is already running for the same, or a similar, pathology.
- The patient doesn't meet an age condition tied to the pathology.
- The condition isn't on the list of recognized severe pathologies.
Common Mistakes
- Using a prescription that's already older than 2 months: this almost always leads to a refusal.
- Forgetting to add an attachment: without an attachment, you can't submit the form.
- Waiting too long to respond to a request for additional information: after 6 months without a response, an automatic refusal follows.
TIP
For the full explanation, including every possible status and how to read the table, see the Approvals guide.