Approvals

TIP

This tab is only visible to official therapists, registered with RIZIV/INAMI.

On this tab in a patient's record, you manage the mutuality approvals that authorize this patient's treatment.

Sophia works here in one of two ways, depending on whether eAgreement is active for this patient.

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Without eAgreement

WARNING

Starting January 2027, this way of working is no longer possible: approvals will then only be requestable through eAgreement. Is eAgreement not active yet for your patients? Turn it on in time under Basic Data.

Is eAgreement not active? Then you see a simple input form with four blocks, one per type of approval:

• Approval e-pathology
• Approval Fa pathology
• Approval Fb pathology
• Approval pathological situation

Each block has the same fields: a start date, an end date, a description, and a counter showing the number of sessions used. Changes are saved automatically.

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With eAgreement

Is eAgreement active for this patient (see the Basic Data tab)? Then instead you see a full table with every eAgreement request, retrieved directly from RIZIV/INAMI.

Before You Can Start

Sophia first needs to establish two things:

1. A therapeutic link with the patient. Does the patient have no national number? Fill this in first at Basic Data. Has no link been found yet? Then Sophia asks for the eID card number (or ISI+ card number, if applicable) of the patient, and you click Create therapeutic link.
2. A gender for the patient. Missing this? Fill it in at Basic Data, or first fetch the eHealth member data: gender is then filled in automatically.

Are both in order? Then the approvals table appears, and Sophia refreshes it automatically as soon as you open the tab.

The Three Buttons at the Top

• Request: opens the form to request a new eAgreement. See Requesting an eAgreement below.
• Consultation: asks RIZIV/INAMI for the current status of every approval. This happens in the background and can take a moment, you'll notice a small spinning icon next to the button.
• Fetch messages: retrieves new messages from RIZIV/INAMI about this patient.

TIP

These three buttons don't show a separate success or failure message. Wait for the spinning icon to disappear, then check the table.

Reading the Table

Per request, you see, among other things: the requestor, the pathology code, a reference number, the creation date, the start and end date, whether the request is completed, a counter, whether it's linked to a prescription, the status, and any messages.

Linked to prescription: a green icon means the approval is linked to a prescription. Click this icon to remove the link (after confirming). A grey icon means there's no link. Linking an approval to a prescription directly is only possible when creating the request itself, not afterward.

Status: a green checkmark means agreed, a red cross means refused, an orange clock means the request is still being processed, and an orange question mark means more information is being requested.

Messages: click the envelope icon to see every message for that specific request, with a timestamp and explanation. In case of a refusal, this is where you find the full, readable reason.

Immediate Approval or Pending Review?

Whether a request jumps straight to "approved," or first stays "pending" for a while, is decided by RIZIV/INAMI itself. Sophia has no influence on this.

• Routine treatments: simple requests that meet every condition, for example extending an ongoing routine treatment, are usually processed automatically and immediately by RIZIV/INAMI.
• Non-routine treatments: a request for Fa pathology, Fb pathology, or a new pathological situation is reviewed manually by the mutuality's medical advisor. This can take anywhere from a few days to several weeks. While this is happening, the status shows the orange pending clock icon.

WARNING

Does RIZIV/INAMI ask for additional information (orange question mark), and you don't respond? After 6 months without a response, the request is automatically refused.

Actions Per Request

Depending on the status, you can:

• Extend: submit a new request that refers to an already approved one.
• Argue: provide additional information when RIZIV/INAMI asks for it.
• Complete: finalize an approved request.
• Cancel: only possible for the therapist who originally submitted the request. This happens immediately, without confirmation.

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Requesting an eAgreement

Click Request (or Extend, Argue, or Complete) to open the form.

1. Choose the prescription. Sophia then automatically fills in a number of fields, such as the number of sessions and the start date, based on this prescription.
2. Choose the pathology code. Only codes matching the chosen prescription are shown.
3. Check the number of sessions, the Condition appearance date, and the Agreement start date.
4. Add at least one attachment: a scan of the prescription is required. Choose the attachment type, choose the document, and click Add attachment. Don't have the document in Sophia yet? Upload it first via Upload new file. Possible types are: Prescription, Previous prescription, Functional report, Medical report, Physiotherapist report, CRA justification, Scoliosis protocol, Rheumatology report, Radiology protocol, and MEVS results. Which attachment is actually requested or useful depends on the pathology and the situation.
5. Optionally fill in extra info, and if needed, link a previous prescription with its own attachments.
6. Click the button at the bottom to submit the request.

WARNING

Without at least one attachment (the prescription), you can't submit the request. The button stays disabled until then.

TIP

Here too, you don't get a separate success or failure message. Close the window, and check the table to see whether your request appears.

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Possible Error Messages

Is a request refused, or does RIZIV/INAMI ask for additional information? Sophia shows the exact, readable reason among that request's messages (see Messages above). Some common reasons:

On refusal:

• 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.
• The information in the attachments doesn't match the information in the request.

When additional information is requested:

• An attachment is missing a signature or a date.
• RIZIV/INAMI asks for a current, detailed medical report, or a functional assessment.
• RIZIV/INAMI asks for a specific protocol, for example for scoliosis (with the curvature angle) or for lymphedema (with the perimetry).

TIP

These are only examples. RIZIV/INAMI can also give other, more specific reasons, depending on the pathology.