Billing a month in Belgium

The monthly billing described in Billing is the same in every country. This page gathers what Belgium adds to it: the INAMI allowance billed to the health insurance fund, the eHealth exchanges that carry it (MDA, eFact, eAgreement), the rules the INAMI applies to absences and departures, and the CPAS.

Each section links to the Belgian page that details the subject.

Two shares on every invoice

In a Belgian nursing home (MR or MRS), each month is billed in two flows, over the same billing period:

  • the mutuality share — the INAMI dependency allowance, covered 100% by the health insurance fund (third-party payer) and sent electronically through eFact;

  • the resident’s share — accommodation, supplements and supplement agreements, care services, medication, adjusted for absences → standard invoices, to the resident, their family or a CPAS.

The allowance is billed under pseudo-codes, not under a price list of your own: the care flat-rate carries its AViQ pseudo-code (for example 770501 for category O), and the same code appears on the expense note (Annexe 12). The amount is the same for every Katz category under the AViQ rates; the category declares the dependency profile to the health insurance fund. Details and rates: The INAMI dependency allowance.

MR and MRS

In Belgium, the sectors a home is licensed for are MR (rest home) and MRS (rest and care home). The stay type shown on the resident cards of the Supplements app, and its MR / MRS filters, are these two sectors. A supplement convention survives an MR ↔ MRS transfer.

The month, step by step, on the Belgian side

The common guide Billing a month, step by step gives the sequence common to every country. In Belgium, it gains its eHealth steps:

  1. Open the period in Billing → Facturation → Billing Periods.

  2. Generate — in the Generate Billing window, Load MDA Success (and Load MDA Pending) pre-fill the residents whose insurability was already checked, for instance by a batch MDA run at the start of the month. The allowance is computed on the days of presence over the INAMI intervention period, with the billed Katz category. The period becomes Generated.

  3. Check insurability — click Check MDA: one request per resident of the period, sent as a batch. The step is done as soon as every resident billed to a mutuality has a request — the responses may come later. Fix the flagged cases (wrong mutuality, loss of insurability); Retry Failed MDA resends the requests that ended in an error. See Insurability (MDA).

  4. Generate eFact — in the Generate eFact Batches window, click Generate Batches: Resthome builds the eFact batches from the period’s mutuality lines, grouped by union of mutualities. A resident with no Katz assessment blocks this step.

  5. Create Invoices — the resident’s share becomes draft invoices; check them, then Confirm them. The period becomes Invoiced.

  6. Send — open eHealth → eFact → Cockpit (or the batches) and click Send all, or send batch by batch. The submissions go out to the insurers through the eHealth network.

  7. Track the responses — click Fetch responses to bring back the acknowledgements and settlements. Each batch moves through Sent → Acknowledged → Accepted / Rejected. In case of a rejection, fix the cause (insurability, dates, amounts) and resend.

  8. Close Period — possible once no invoice is left in draft, every batch has reached a final outcome, no mutuality line is outside a batch and every service refused by the insurer has been corrected.

  9. Print the expense notes — Annexe 12, individual and summary, once the month is billed.

The period points at the next step itself: its highlighted button (and the To do column of the Billing Periods list) reads Check insurability (MDA), then Generate the eFact envoi, then Create the invoices. The order is advice, not a lock: Check MDA and Generate eFact stay available on an Invoiced period, for a resident added late or a batch rebuilt.

The screens, the pre-send checks and the advanced buttons are described in Electronic invoicing (eFact); the whole journey from admission to payment is in The billing journey.

The month-end checklist, eHealth side

The Month-end checklist applies as is. In Belgium, it gains the following eHealth steps.

Insurability (MDA)

Run the batch MDA for the month: it confirms who is insured and, above all, which mutuality actually responds. A resident who changed fund without telling you is caught here — not by an eFact rejection three weeks later.

  • Every resident must reach the Success status.

  • Handle the Not insured cases: their share goes to the resident, not to the mutuality.

  • Retry the errors and the no-responses — on the period, Retry Failed MDA resends the requests that ended in an error.

→ Insurability (MDA) · MDA errors

The single most useful step

Most eFact rejections come from a wrong mutuality or a lost insurability. Running a batch MDA at the start of the month (eHealth → Insurability → MDA Batches), then Check MDA on the generated period for anyone left, removes that whole class of problems before the eFact leaves.

Katz assessments

The billed Katz category is the profile declared to the mutuality with the allowance. A missing or expired assessment leaves the resident in category O by default, and the billing no longer matches the agreement. The Katz to do counter lists them.

→ The Katz assessment · The INAMI dependency allowance

eFact batches and responses

Generate eFact builds one batch per insurer (per union of mutualities), right after the MDA and before the invoices. Check them, then send. Each batch then goes through an acknowledgement and a settlement:

  • rejected lines — fix the cause and issue a remainder;

  • rejected batch — a format problem, to escalate;

  • settlement — check the amount paid against the amount accepted.

The eFact Cockpit gathers everything to be done into stacks: to send, awaiting insurer, to correct, to reconcile, overdue payments.

→ eFact rejections · Settlements and payments

The deadline

eFact batches must reach the insurer by the 20th of the following month. Working backwards, the MDA and the corrections should be done in the first week — which leaves room to handle a rejection without missing the deadline.

Step

Done when

MDA

every resident is at Success

Katz

no Katz to do left

eFact

the batches are sent

Follow up

the eFact Cockpit stacks are empty

Absences and hospitalisations seen by the INAMI

The common page Absences and hospitalisations explains how to record an absence. In Belgium, two rules apply on top.

The noon rule. The INAMI allowance is computed on the presence days. The count follows a presence-at-noon rule (Brussels time): presence at noon determines whether the day counts. The dates and times of departure and return therefore matter — Resthome relies on them for an exact count.

Notification to the mutuality. Some absences must be reported:

  • an absence of more than 72 hours, or any hospitalisation, prepares an Annexe 11 (departure notification);

  • the resident’s return prepares an Annexe 7 (readmission).

Resthome creates these notifications at the moment you record the absence and the return; you only have to check and send them. Deleting an absence entered by mistake withdraws them, as long as the mutuality has not validated them.

→ Agreements (eAgreement) · Collective holidays

Departure and death

Closing a stay (see Departure and death) prepares the Annexe 11 departure notification to the health insurance fund.

The INAMI allowance, unlike the accommodation, is billed on the month actually served: it stops at the end of the INAMI intervention. If a resident leaves or dies during an already invoiced month, the self-check flags the over-declared allowance and Resthome prepares the credit note or remainder, and a corrective batch on the mutuality side if needed. The Annexe 12 reflects the actual days of presence.

→ Agreements (eAgreement) · Electronic invoicing (eFact)

Supplements declared to the mutuality

In the supplements catalog (Configuration → Catalog), the AViQ code field holds the declaration pseudo-code of a supplement, when it is declared to the insurance body.

Depending on its category, a supplement is either declared to the insurance body in the eFact (ET50 record), or billed only on the resident’s invoice. This setting is made on the product category — see Billing settings.

The CPAS in split billing

A CPAS (Public Centre for Social Welfare) steps in on the resident’s share only — accommodation and supplements. The INAMI allowance is never split: it goes to the mutuality through eFact.

  • The CPAS pays everything → set the resident’s Billing contact to the CPAS.

  • The CPAS pays part of it → add the CPAS as a debtor in split billing, with its percentage, and the other payers (resident, family) for the balance.

Recording the decision and routing the invoice are detailed in CPAS coverage.

What’s next