Mutuality list
- Bertrand Anckaert
- Danielle Rubas (Deactivated)
Predictions are activated when the corresponding tables are present
Header fields
Column | Description | Data type |
|---|---|---|
Insured name | Full name of the person insured | string |
Insured NISZ | National insurance number of the person insured | string |
Insured Birthdate | Date of birth of the person insured | date |
Line items
We consider different types of lines
header lines → if header fields can be repeated, we also provide them as header lines so that they can be associated to the right note
detail lines → there are two types of detail lines
Those which do not include a subtotal: Detail_MUT
Often included date, nomeclature number, description, …
But never a TK amount (actual paid amount)
Those which do include a subtotal: Item_With_Subtotal
Include a TK amount
subtotal → this is the subtotal for a note. There can be multiple subtotals per document
total → this is the total for the document “there can be only one”
Relation between detail_MUT, Item_With_Subtotal, and subtotal
a detail_MUT line does not have the column “TK amount” (amount actually paid)
a subtotal line only has amounts (no description, nomenclature code, …)
sometimes a line contains information both on the detail line and on the subtotal. This is done when the note consists of exactly one item
An Item_With_Subtotal therefore has the fields of a detail_MUT line (description, nomenclature code) and the fields of a subtotal line (notably TK amount)
An Item_With_Subtotal line cannot be summed up in another subtotal line (it can be summed up into the document total)
detail_MUT
Table name: detail_MUT
Column | Description | Data type |
|---|---|---|
Date from | Date when the treatment period of the patient starts | date |
Date to | Date when the treatment period of the patient ends | date |
nomenclature code | Unique code of the service given | alphanumeric |
description | Description of the service given | string |
Number of units | Quantity of service units given | integer |
MUT amount | Amount refunded by the mutuality | float |
TK amount | Amount actually paid by the patient (includes both TTK, the regulated price and SUP, the surcharge on top of the regulated price) | float |
TTK amount | Amount charged by the caregiver (honorarium) in line with the convention/regulation | float |
PA amount | Amount to be paid by the patient (remgeld) | float |
SUP amount | Supplement, charge which is made on top of the regulated honorarium/prices (supplement) | float |
PA + SUP amount | Total amount of PA and SUP | float |
Subtotal line and Total line
Table names:
Subtotal line
Total line
Column | Description | Data type |
|---|---|---|
MUT amount | Total amount refunded by the mutuality | float |
TK amount | Total amount actually paid by the patient | float |
TTK amount | Total amount charged by the caregiver (honorarium) in line with the convention/regulation | float |
PA amount | Total amount to be paid by the patient | float |
SUP amount | Total supplement, charge made on top of regulated honorarium/prices (supplement) | float |
PA + SUP Amount | Total amount of PA and SUP | float |
Example
Consider the example below
Column mapping to field names
Total = MUT
Montant payé par l’affilié = TK
Honoraire = TTK
Quote-part personelle = PA
Supplément = SUP
In this case, the patient paid a visit to a certain care provider
The all-in price was 50€ (TK, “montant payé par l’affilié”), this consists of
The price in line with convention/regulation is 29.04€ (TTK, “Honoraire”), which consists of
The part paid for by the mutuality 17.04€ (MUT, “Total”)
The personal share of 12€ (PA, “Quote-part personnelle”)
The supplement of 20.96€ (SUP, “Supplément”)
In math terms
TK = TTK + SUP
TTK = MUT + PA