Refac
Refac is the CM system to handle the billing of nurses in the third-party payer scheme.
Refac supplies, among other things, a settlement file (or, if applicable, a rejection file), which replaces the settlement on paper.
UCP (Unique Point of Contact)
Every nurse has a UCP. This is the Unique Contact Point for all questions about invoicing and agreements .
For technical questions, the software supplier remains the first point of contact.
Frequently Asked Questions
In the past, you had to deliver shipments of nursing care both electronically and on paper to your Unique Contact Point (UCP). This is no longer necessary for shipments that we have received via MyCarenet since 1 July 2015.
From now on, you no longer have to send paper documents (certificates, summary statements, regulations, etc.) to your UCP . The treatment in Refac takes place without waiting for the paper certificates. You keep the prescriptions in the patient's nursing file for five years. They must remain available to the advising physician.
Keep these testimonials together with the duplicates of the testimonials that you submitted to CM at the time. The retention period is also five years.
Do a network consultation (message MyCarenet 801000) to check the insurability. Because the payment obligation resulting from this consultation is valid for thirty days, it is best to do such a network consultation every month.
Important : the details of the payment commitment (message MyCarenet 801900) must also be included in your billing (record 20, zones 42-45, 53 to 58).
By submitting your requests for approvals electronically via MyCarenet, you can avoid these rejections. The main advantage of this method is that you receive a confirmation of receipt (which is not the case for applications on paper).
Payment is made in one installment within the convention term of two weeks after the date of receipt of the accepted file.
We respect the order in which the invoices/shipments are submitted and are also dependent on the amounts made available by the INAMI/RIZIV. The payment reference remains the same as before the introduction of Refac.
Due to checks, it is possible that there are corrections to previous shipments. These amounts will be compensated with the most recent shipment. The amount on your account therefore corresponds to the amount on your statement file, less any corrections made.
We inform you about these manual corrections with an M38 verification sheet (on paper). You will also find more details on your payment letter.
Surf to the NIHDI website and consult the file. Or contact your software supplier, because he can possibly integrate this file into your software program.
With Refac this will no longer be possible , except in exceptional and justified cases that have been discussed with your UCP. We opt to provide you with a payment file.
No, the improvements made are removed from the settlement because Refac is an automatic control system. You will receive the rejections via a settlement file. You can correct it yourself and resubmit it with a next billing (the following month).
Zone 149 of the checkout file is the 'comments zone' which provides additional information about the reason for the rejection. This allows to interpret the error code. This information is not listed systematically, but is communicated when possible (e.g. for error code 502255, this zone is empty if there are too many services involved).
| Error code | Description in zone 149 |
|---|---|
| R500545 | Hospitalized in {place} from {date} to {date} |
| R500403 | The patient has a diabetes care plan on that date |
| R500444 | {prest} {date} of {date} invoiced by {third party} |
| R500445 | {prest} {date} of {date} invoiced by {third party} |
| R501942 | Ceiling exceeded by {no paying third party} in fact {no individual invoice} |
| R500450 | The member is affiliated with the medical house {no. medical house} |
| R502255 | {prest} {date} of {date} invoiced by {third party} |
This rejection occurs if the number of the UCP has not been entered correctly in the zone 'Health fund of destination' (zone 18 of records 20 and 80).
To solve this problem, you must enter your UCP number in this zone and resubmit your billing (via MyCarenet).
If you do not know how to enter your UCP number in this zone, please contact your software supplier. If you do not know your UCP number, go to the first question in the 'Contact' section .
This is an informational error code . This type of error code is never included in the checkout file (message 920900), but only in the rejection information file (message 920098).
More information can be found in the invoicing instructions of the RIZIV (appendix 5.1 continuation 1, continuation 2) .
The regulations only allow one billing of the first basic provision of the day .
Our checks therefore reject the double billing of this first basic provision, even if this is done by another nurse. The rejection occurs with the error code 502255: 'Exceeded maximum number of units during the billed period'.
To avoid double billing for the first basic provision, you can consult with other nurses via, among other things, the patient's nursing file. It is important that you can add a second basic provision to your software package without the first basic provision being charged. If not, contact your software vendor.
If you get the error code 502255, you can invoice again in a subsequent shipment with the second basic issue instead of the first.
The same principles apply to a double billing of the second basic provision of the day.
A full day (rejection 500118) or an entire block of achievements (rejection 500119) is rejected by the rejection of an achievement that is part of the same day or block of achievements .
This was agreed in order to facilitate the resubmission of the rejected performance.
It is sufficient to improve only the performance that caused the rejection. In this way, the lines that were first rejected with the error code 500118 or 500119 will also be accepted.
These error codes appear if you bill for benefits 423135, 423150, 423172, 423194, 423216, 423231, 423334 while the patient already has a diabetes care plan .
The rejection is based on the national nurses agreement (last paragraph art. 10bis, 4):
'For patients who are included in a care pathway, the benefits in kind for diabetes patients described in Article 8, §1, 1°, VI and 2°, VI of the nomenclature cannot be certified.'
These rejections occur with an unauthorized cumul . The data of the performance that causes this accumulation is located in the 'Comments' zone (zone 149) of the settlement file.
If it concerns two services in the same consignment, these two erroneously cumulated services will be rejected. In that case, you can resubmit one of the two services with your next billing (the following month).
This rejection applies to the additional fee for nursing care if repeat dispensations (428035, 428050, 428072) are inconsistent with statistical records (R 50 Z 3 = 9).
If there is that day:
- a provision is 428035, 428050 or 428072, there must be at least a third basic provision;
- two provisions are 428035, 428050 or 428072, there must be at least a third and a fourth basic provision;
- three provisions are 428035, 428050 or 428072, there must be at least a third, a fourth and a fifth basic provision.
In addition, the care provider for the 428035, 428050 and 428072 provisions must be the same as for the basic provision.
The legal basis of this rejection is Article 8, §5quater:
'Provisions 428035, 428050 and 428072 can be certified for the 3rd, 4th and 5th visit to the same patient on the same care day for heavily care-dependent patients who benefit from a provision described in §1, 1°, II and IV, in §1, 2°, II and IV and in §1, 3°, II except for benefits 427173 and 427195. Only the care provider who actually performs the third or subsequent visits can charge for this benefit. This provision can be charged a maximum of once per care day for the 3rd visit, a maximum of once per care day for the fourth visit and a maximum of once per care day for the fifth visit.'
Rejection 500464 has the description: 'Provision can only be invoiced after one or more other provisions have been or will be invoiced first.'
According to the provisions of Art. 8 §8ter, the provision 424874 can only be attested after the provision 424896 has been attested.
Since 30 June 2016, our system checks whether the required notifications are in order when billing flat-rate fees for palliative patients.
- Notification by the GP: this notification must be the first to be registered in our system.
- 'Notification of nursing care for a palliative patient' that you enter as a nurse via your software package (message MyCareNet 420900): the notification can be entered with retroactive effect of a maximum of ten days. It will be rejected if you do it at a time when the GP's notification has not yet been registered. If the general practitioner still puts the notification in order within thirty days after this rejection, we can still approve your notification (which we had previously rejected).
If flat-rate fees invoiced by you have been rejected, this means that one or both notifications are missing or have not been done correctly .
What should you do?
- The notification from the GP is missing: ask the doctor to put this in order as soon as possible.
- Your notification is missing or has not been done correctly: correct it via your software package (message MyCareNet 420900).
You will receive a rejection file (message MyCarenet 920099) in two situations :
- at least one blocking error has been detected;
- the percentage of rejections in your invoice is higher than 5%.
If you receive such a rejection file, make the necessary corrections (see answers on this page) and resubmit the shipment with the same shipment number.
There is also another type of rejection file (message MyCarenet 920999). The procedure in that situation can be found in the next question.
A rejection caused by the message MyCarenet 920999 can have two causes .
- It is a problem of uniqueness.
This means that you have sent the same shipment twice (with the same shipment number). In this case there are two possibilities.- Or you will receive a file for information (message MyCarenet 920098) indicating that the first billing file sent has been accepted. You do not have to submit the shipment again.
- Or you will receive a rejection file (message MyCarenet 920099) for the first billing file submitted. You can submit a new billing file.
- An error is detected during the preliminary checks on the header records and records of type 95 and 96.
Correct this error, resubmit your billing file and contact your software supplier or surf to http://www.mycarenet.be .
Another type of rejection file also exists (message MyCarenet 920099). The procedure in that situation can be found in the previous question.
You have submitted a shipment for a certain billing period, followed by a negative shipment for the same period. Both shipments were accepted by CM. If you want to submit a new shipment via Refac for that billing period, you will receive the rejection message 920999.
The refusal indicates that you have used the same shipment number as for a previous shipment.
Once a shipment has been accepted by CosMos (Refac's predecessor) or Refac, that shipment number may no longer be used. This also applies if a shipment has been canceled due to a negative shipment. The shipment number remains registered in our systems as an accepted shipment, despite the cancellation afterwards.
To find out who your UCP is, please contact:
- your software supplier (who also takes care of the MyCarenet formalities);
- or with the LCM Service Desk via [email protected] .
You will find the contact details of your UCP in this overview .
That is possible in certain cases. For example, if you move or if you live in Wallonia but work in a Dutch-speaking context and want to collaborate with a Dutch-speaking UCP.
In this case, contact your current UCP to request the change and state the reason for your question. We can make changes to our systems four times a year .
If you invoice the nursing services in your own name, you will have a UCP based on this statute.
If you don't know your UCP, consult the answer to the previous question.
Your UCP is the same as that of your grouping . You then primarily direct your questions to your group. If you contact your UCP yourself, clearly state the name of your billing group.
Your software supplier remains your first point of contact for all technical questions.
Your UCP is your point of contact for all questions and information. You can therefore also report this change to it.
