Glossary — Belgium

The terms and acronyms that come from Belgian rules and institutions, explained simply. Each entry links, where useful, to the page that covers it in detail. The terms valid in every country are in the Glossary.

Annexe 7

eHealth admission agreement document (coverage) sent to the health insurance fund at the start of a stay or on a readmission after an absence. See: Agreements (eAgreement)

Annexe 10

Care-agreement update document, prepared upon a validated Katz aggravation (the aggravation reason is carried over into it; the clinician’s signature completes it). See: The Katz assessment

Annexe 11

Discharge notification sent to the health insurance fund on an absence of more than 72 h, a hospitalisation, or an end of stay / a death. See: Agreements (eAgreement)

Annexe 12

The expense note: an individual note per resident for the expenses advanced, and a summary note per insurance organisation. See: The Expense Note (Annexe 12)

AViQ

The Walloon agency that sets the rates of the dependency allowance and funds the facility through the institutional allowance. Under the AViQ rates, the dependency allowance is the same amount for every Katz category. See: Institutional allowance

BIM (status)

Increased-reimbursement beneficiary: a social status granting the right to better reimbursement. The MDA pulls it automatically onto the resident’s record. See: Insurability (MDA)

CPAS

Public Centre for Social Welfare of the resident’s municipality. It can cover all or part of the resident’s personal share (accommodation and supplements) — never the dependency allowance, which goes to the health insurance fund. See: CPAS coverage

CSJ (day care centre)

Day care centre (centre de soins de jour): a centre whose users live at home and come for the day. Its forfait is paid per day that earns it — six hours, an arrival by noon — for the CSJ categories F, Fd and D. See: Day care centre (CSJ)

Day place

A place in a day room, shared by the day care users who come on different days — never a licensed bed. A day care stay only goes in a day place, and a residential stay never does. See: Setting up a day care centre

eAgreement

Care coverage agreement (linked to the Katz category and the package), exchanged electronically with the health insurance fund via eHealth. See: Agreements (eAgreement)

eAgreement Light

The simple notifications tied to the resident’s movements (admission, absence, departure, return) that Resthome generates automatically as you work. See: Agreements (eAgreement)

eFact

Electronic transmission of the insurer’s share (the INAMI package) to the health insurers over the eHealth / MyCareNet network, with tracking of acknowledgements, statements, acceptances and rejections. See: Electronic invoicing (eFact)

eFact batch

An electronic file grouping the packages of one eFact transmission. Resthome builds one batch per insurer union. See: Electronic invoicing (eFact)

eFact Cockpit

Monitoring view for electronic billing: the status of all batches and transmissions at a glance (transmitted, accepted, rejected, pending). See: Electronic invoicing (eFact)

eHealth

Belgian platform for secure electronic exchanges in healthcare. Resthome uses it for the MDA, the eAgreement and eFact (via MyCareNet / WalCareNet). See: eHealth

INAMI

National Institute for Health and Disability Insurance (in Dutch: RIZIV). The federal body that sets the rules and the packages for health-care insurance.

INAMI package

Daily amount covered by the health insurance fund for care, determined by the resident’s Katz category and calculated on their days of presence. See: The INAMI dependency allowance

Institutional allowance

What the facility receives per day and per resident for a funding year, computed from the days billed to the health insurers and the staff present over the reference period. See: Institutional allowance

Insurer (OA)

The resident’s health insurance fund (mutualité, organisme assureur), recipient of the INAMI share via eFact. Insurers are grouped into large unions. See: Insurability (MDA)

Insurer union

The large families of insurers used to group eFact transmissions: 100 (Alliance nationale), 300 (Solidaris), 500 (Union nationale), 600 (CAAMI), 900 (HR Rail)… See: Electronic invoicing (eFact)

Katz (scale)

Scale measuring a resident’s degree of dependency across 6 criteria (washing, dressing, transfer and mobility, using the toilet, continence, eating), each rated from 1 to 4. It determines the category (O, A, B, C, Cd / Cc) and therefore the package. See: The Katz assessment

MDA (insurability)

Member Data — the check of a resident’s insurability and of their exact health insurance fund with MyCareNet / WalCareNet for a given period. An essential prerequisite for eFact. See: Insurability (MDA)

MR / MRS

Rest home (MR) and rest and care home (MRS) — the two types of residential facility for the elderly, with distinct care levels and packages. In Dutch: ROB / RVT (grouped under the term woonzorgcentrum). See: Admitting a resident in Belgium

MyCareNet / WalCareNet

The health insurance funds’ electronic gateways (via eHealth) that Resthome queries for the MDA, the eAgreement and eFact. WalCareNet is the Walloon counterpart.

NISS

Social Security Identification Number (the national register number). Essential for sending a resident’s MDA and eAgreement agreements. See: Admitting a resident in Belgium

Noon rule

Day-counting convention: it is presence at noon (Brussels time) that determines whether a day counts toward the package, hence the importance of departure and return dates and times. See: Billing a month in Belgium

Pseudo-code

The code under which the allowance is billed to the health insurance fund: each Katz category (for example 770501 for category O) and each CSJ category carries its own on the INAMI rates, and the same code appears on the Annexe 12. A supplement declared to the insurer carries its declaration pseudo-code too. Always say pseudo-code, never “INAMI code”. See: Billing a month in Belgium

Reintegration

Shifting lines from the resident to the health insurance fund (or the reverse) when insurability changes between two MDA checks (loss then return of insurability, for example). See: Insurability (MDA)

SAM

The Belgian authentic-source medication database, with the ATC code, the BCFI class, the Black Triangle and the SmPC / leaflet, searched with the Search SAM wizard. See: The SAM medication database

Third-party payer

In Belgium, the health insurance fund pays its share directly to the facility via eFact, the resident settling only their own share. In Dutch: derdebetaler. See: Electronic invoicing (eFact)

Further reading