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Roadmap for the introduction of Tarmed/KVG

Thursday, 20 November 2003
PDF version in german & english

Dear developers

As you probably know, on 1.1.2004 Tarmed becomes the mandatory tariff for KVG/VVG. Of course this has a plethora of consequences for the Sumex 1+ modules.
In the following we try to describe the necessary adjustments and patches in the Sumex 1+ modules, that should allow you to master the introduction Tarmed/KVG using the modules as seamless as possible. The Forum Datenaustausch (Suva, Santésuisse, FMH, H+) has obligatorily specified the introduction scenario in their meeting of 31.10.2003 (see pdf file "Einführungsplan").

From it the following facts result:

  1. for electronic invoices the XML schema definitions V3.0 (as used in the XMLManagers V3.0) are valid until 30.6.2005,
     
  2. for printed invoices the standardized invoice forms V4.0 (ERF4.0) must be compellingly used starting from 1.1.2004,
     
  3. for printed reminders the standardized reminder forms V4.0 must be compellingly used starting from 1.1.2004

Due to the remaining time left and the compelling use of ERF4.0 starting from 1.1.2004 Suva decided upon the following introduction path regarding the Sumex 1+ modules:

The Sumex 1+ modules are modified/patched without changing the DLL interfaces in such a way that developers can use the existing versions V3.0 and adjust their own software to a minimum to become Tarmed/KVG suited! At a later time the new Sumex 1+ modules V4.0 with new and adapted interfaces are supplied.

The individual patches
tarmedValidator:
  1. Tax Point Value (TPV) table: since the publication date of the official TPV table is unclear at the moment we patch the meaning of the external scaling factors f(ex, MT) and f(ex, TT) to allow for a self declaration system. If one set a external scaling factor f(ex, XX)<0, this is interpreted as a TPV(XX) and f(ex, XX) is internally set/used as 1. If no external scaling factor is defined or if f(ex, XX)>0, the normal procedure is applied with the default TPV=1.
  2. VAT requirements: Suva relinquish to enforce the VAT information from Tarmed V3.0 (this concerns only individual pathology services), since the a enforcement is connected with a new DLL interface and a new Tarmed database

MDInvoiceRequest:
  1. Printed tier garant (TG) invoices and TrustX: A VESR line with the first two digits ij>50 can be used as initial value for the trust center identification. In all invoice forms with the exception of the TG reclaim voucher (Rückerstattungsbeleg) these initial digits are silently substituted with 01
  2. TrustX and XML pattern: It is currently not possible to use a VESR line with the first two digits ij>50, since such a VESR line is not XML schema valid!
  3. NIF number and IVG invoices: the NIF number can be entered using the invoice remark field (bstrRemark in IMDInvoiceRequest). The format should be NIF =...... This procedure allows for the usage of the electronic invoice path as well. IV has agreed to accept such a procedure as a substitute for the NIF field in ERF 4.0.
  4. Contribution place (Erbringungsort) on the MD's invoice: The default contribution place is "practice". This value is changed to "hospital" by using the following ad hoc rule. If at least 1 Tarmed service is defined with medical role "enMedicalRoleSelfEmployed" and biller role "enBillingRoleMT" (see ITarmedInput:SetPhysician) the contribution place "hospital" is set (TT portion is then effectively set 0).
  5. Obligation flag of a service (Pflichtleistung) in printed invoices: Currently there is no interface function allowing to define the obligation service attribute (OSA). Therefore an ad hoc rule set is defined to extract the flag given a certain service.
    • all Tarmed services posses a OAS=true flag except those, which are explicitly specified as OAS=false in the Tarmed database.
    • all drugs with a status SL=true are set as OSA=true, all others have a flag OSA=false
    • all services of all other tariff catalogues other than Tarmed and drugs posses an flag OSA=true
  6. It will be possible to select the used invoice forms via the argument bstrPrintTemplate of the function print (IMDInvoiceRequestManager:print). This allows for a greater flexibility of your printing requirements. The specifications will be published.

MDInvoiceResponse:
  • No changes necessary

HospitalInvoiceRequest:
  • see MDInvoiceRequest

HospitalInvoiceResponse:
  • No changes necessary

ReminderRequest:
  1. Suva permits the use of the role-independent reminder forms V3.0 (ReminderRequest V3.0) as an alternative to the usage of the role-dependent invoice forms V4.0. By using the V3.0 forms an additional reprint of the corresponding invoice (Nachdruck) must accompany the reminder compellingly. A change request is submitted to the Forum Datenaustausch to generally permit the above described procedure.
ReminderResponse:
  • No changes necessary

Cancel manager:
  • No changes necessary

The releases of the Patches
The modified modules (DLLs and data bases) will be released -if all data become available- in week 49.
We try our best to reach that goal!

Sumex 1+ modules V4.0
As we can foresee now around July 2004 the next generation of DLLs with new and/or adapted interfaces will become available covering the complete range of ERF4.0 and XML4.0 requirements/standards. From that time on the DLLs V3.0 are still updated but are no longer under active development (no upgrades).

Please stay tuned about further information about the roadmap to version 4.0.