How do I check a resident’s insurability (MDA)?

From the resident’s record or a billing period, run Check MDA. Resthome queries MyCareNet/WalCareNet and confirms coverage, as an individual check (immediate) or as a batch for a whole period.

What does Resthome update after a successful MDA?

The actual health insurance fund (insurer), the BIM status, the membership number, and the date of death if the insurer reports it. Date of birth and sex are overwritten with the insurer’s values — a birth date that disagrees with the NISS gets the eFact rejected — and each change is listed in the resident’s thread.

Why can’t I edit a resident’s date of birth any more?

Once an MDA reply exists, the fields it owns (name, date of birth, sex, insurer) are locked so a manual edit cannot contradict the insurer. A manager can lift the lock record by record with “Allow manual identity edit”, but the next MDA refresh will overwrite the manual value.

What should I do if a resident isn’t insured?

Don’t bill them under third-party payer (tiers payant) for the period, or the invoice will be rejected. Clarify the situation with the resident or their health insurance fund, and bill the amount to the resident in the meantime.

Insurability (MDA)¶

Before billing, you must make sure the resident’s insurability is in order and know their exact health insurance fund. The MDA queries MyCareNet / WalCareNet for you and retrieves up-to-date information for a given period. It’s the essential prerequisite before sending eFact.

Menu: eHealth → Insurability → MDA Requests (and MDA Batches).

MDA requests list: one row per request with the resident, the current and responding health insurance funds, the period and the status

What the MDA retrieves¶

Insured or not for the period.
The health insurance fund (OA) that actually responded — compared with the one on the profile (a change of health insurance fund is detected and flagged).
The BIM status (increased reimbursement).

MDA request for a beneficiary with BIM status: the BIM confirmed box is ticked and the CT1/CT2 codes are those of increased reimbursement

The coverage periods (start/end dates; several sub-periods if the insurance changed during the interval).
The membership number with the health insurance fund.
Where applicable: third-party payer (tiers payant), date of death reported by the OA, and depending on the request, the reference pharmacy, the DMG, the palliative status, or a hospitalization.

The “not in order” case

If the beneficiary codes come back as zero (insured but unpaid contributions / a problematic file), Resthome shows an alert: the resident is affiliated but not in order. Clarify this with them or their health insurance fund before billing the OA.

Prerequisites¶

To check

The resident has a valid NISS.
The facility’s INAMI number is configured.
The eHealth certificate is active.

The profile’s health insurance fund isn’t blocking (the actual OA is identified by the response), but filling it in helps spot changes.

Resthome also applies automatic period rules: the end must be after the start, at most 5 years of history, and a standard MDA doesn’t go beyond the current month.

Individual check¶

Create an MDA request (resident, NISS pre-filled, period = the current month by default).
Click Send (Sync): sending is immediate and the response comes back right away.
Review the summary and the insurability periods.

Completed MDA request, Insurability tab: three coverage periods with their CT1/CT2 codes and the health insurance fund code

One MDA per resident and per period

Running a check again for the same resident and the same period reuses the existing request — no duplicate.

Batch check (recommended at the start of the month)¶

For a whole period, run the batch check: select the residents (you can paste a column of names/NISS), the period, and send the whole batch at once.

Immediate send (Sync): for small volumes.
Grouped send (Async): for large monthly batches — the request goes out, and the response is retrieved a bit later with Check responses (requires at least 2 residents).

The batch shows counters: Insured, Not insured, Errors, Pending, and “Deaths detected”.

MDA batch with its counters — Insured, Not insured, Errors, Pending — and the list of residents in the batch

The right habit

Run the MDA at the start of the month, before generating invoices: you avoid later eFact rejections caused by a wrong health insurance fund or a loss of insurability.

Statuses¶

Status	Meaning
Draft	Not yet sent
Sent / Pending	Transmitted, response awaited (especially when grouped)
Success	Response received, resident insured
Not insured	Response OK, but resident not covered
No response	The platform closed without a response from an OA (retry)
Error	The OA or the platform returned an error

MDA request whose response reports a beneficiary who is not insured for the period

Buttons¶

Button	Effect
Send (Sync)	Immediate send, response right away
Check response	Retrieves a response from a grouped send
Retry	Resets to draft to resend
Contact the OA	Opens a pre-filled email to the health insurance fund that responded
Report to InterMut	Opens an email to the CIN for platform blockages

On a batch, the same actions exist in grouped form (Send, Check responses, Retry errors, Retry no-responses).

What Resthome updates automatically¶

After a successful response, the resident record is corrected automatically:

Health insurance fund (OA): if the OA that responds differs from the profile, the profile is updated (and the OA created if it was missing).
BIM status and membership number.
Date of birth and sex: the insurer’s values win, even when the record already holds something else (see below).
Date of death if the OA reports it → alert on the record.

On identity, the insurer wins¶

Date of birth and sex are overwritten, not merely filled in when empty. This is deliberate: a birth date that disagrees with the NISS gets the eFact rejected, and a typo entered at admission would otherwise survive every check — the operator believing the MDA had validated the file. The insurer applies the same rule.

When an existing value changes, Resthome posts MDA — identity corrected in the resident’s thread, listing each change as ~~old~~ → new. Nothing moves silently.

The date of death is the exception

If the insurer reports a date of death that differs from the one on file, Resthome does not overwrite it: it posts “MDA — date of death differs” and leaves you to arbitrate. That date closes the stay and caps the allowance — too consequential to change automatically.

Identity fields are locked after the first reply¶

Once a resident has an MDA reply, the fields the MDA owns — name, date of birth, sex, health insurance fund — become read-only on the record. It prevents a manual edit from silently contradicting what the insurer holds.

The lock is not absolute:

before any MDA the fields are free — that is how you create a candidate;
a manager can lift it record by record with Allow manual identity edit.

Lifting the lock is temporary

Use Allow manual identity edit only when the insurer’s reply is genuinely wrong. The next MDA refresh overwrites your correction — settle the disagreement with the insurer rather than maintaining the difference by hand.

Safeguard for special schemes

For residents under a special scheme (INIG, EEC, Fedasil, foreign, private…), Resthome does not overwrite the profile’s health insurance fund: a message explains that the MDA response was ignored so as not to break a non-standard coverage.

Reinstatement (loss then return of insurability)¶

Resthome compares with the previous check:

Not insured → insured: a notification appears on the period, and the Reinstatement action lets you move the lines that had been billed to the resident over to the OA.
Insured → not insured: Resthome flags that the resident is “no longer in order” — their dependency fee (forfait) is excluded from OA billing for the period and billed to the resident until they are reinstated.

Error handling¶

Situation	What to do
No response (platform)	Retry no-responses; if it persists, Report to InterMut
OA rejection	Contact the OA (reason shown)
Technical error	Report to InterMut
Resident with no health insurance fund	Non-blocking: the actual OA comes from the response
Pending (grouped)	Check responses or wait