Announcements of the federal government
, Kdö.R., Berlin - on the one hand - and the GKV-Spitzenverband (National Association of Health Insurance Funds), Kdö.R., Berlin - on the other hand - agree the following:41. Change to the agreement on forms for statutory health care (Appendix 2 BMV-Ä)
from 1 April 1995
Article 1
Changes to the form agreement
1. Numbers 2.55, 2.55.1 and 2.55.2 are changed as follows:
" 2.55 Model 55: Certificate of serious chronic illness in accordance with . § 62 SGB V (as of 10.2016) * 1
2.55.1 For the certification of serious chronic illness according to According to § 62 SGB V, the attached sample 55 is to be used. The sample will be available in the practices from October 1st, 2016.
2.55.2 Yellow color is to be used for surface printing. No. 1.1.5 applies accordingly. The form is in DIN A6 landscape format. “
Article 2
Changes to the explanations of the form
1. The form explanations for sample 10 change as follows:
" Sample 10: Referral slip for laboratory tests as an order service
For the referral for the performance of the services of Chapter 32 EBM and the corresponding medical laboratory services of Sections 1.7 and 30.12.2 EBM, as well as for transfers for the performance of services according to the fee schedule items in Sections 11.4 and 19.4 EBM, sample 10 (and not to use sample 6).
A referral slip for laboratory tests as an order service may only be issued if the referring contract doctor has been presented with valid electronic health card in the relevant quarter. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.
The referral slip for laboratory tests is divided into two parts. The upper part of the form is used for identification. The lower part is the order part. Both parts must be completed by the referring contract doctor.
When filling out or reading out the fields, please note the following:
Announcements of the federal government
41. Change to the agreement on forms for statutory health care (Appendix 2 BMV-Ä)
from 1 April 1995
Article 1
Changes to the form agreement
1. Numbers 2.55, 2.55.1 and 2.55.2 are changed as follows:
" 2.55 Model 55: Certificate of serious chronic illness in accordance with . § 62 SGB V (as of 10.2016) * 1
2.55.1 For the certification of serious chronic illness according to According to § 62 SGB V, the attached sample 55 is to be used. The sample will be available in the practices from October 1st, 2016.
2.55.2 Yellow color is to be used for surface printing. No. 1.1.5 applies accordingly. The form is in DIN A6 landscape format. “
Article 2
Changes to the explanations of the form
1. The form explanations for sample 10 change as follows:
" Sample 10: Referral slip for laboratory tests as an order service
For the referral for the performance of the services of Chapter 32 EBM and the corresponding medical laboratory services of Sections 1.7 and 30.12.2 EBM, as well as for transfers for the performance of services according to the fee schedule items in Sections 11.4 and 19.4 EBM, sample 10 (and not to use sample 6).
A referral slip for laboratory tests as an order service may only be issued if the referring contract doctor has been presented with valid electronic health card in the relevant quarter. Exceptions are permitted if, for example, B. the measures to be initiated are urgently required or the referring contract doctor knows beyond doubt the health insurance provider.
The referral slip for laboratory tests is divided into two parts. The upper part of the form is used for identification. The lower part is the order part. Both parts must be completed by the referring contract doctor.
When filling out or reading out the fields, please note the following:
Type of service (curative, preventive, in the case of treatment by attending physicians, conception regulation / sterilization / termination of pregnancy)
The referring contract doctor must indicate whether the order within the scope of curative care, the Prevention, the conception regulation / sterilization / termination of pregnancy or with medical treatment takes place.
Accident, consequences of accidents
The referring contract doctor must indicate if the treatment is necessary due to or as consequence of an accident so that the health insurance companies can claim costs from third parties medical care if the accident field is not ticked in the event of an accident.
Order number of the laboratory
The framed field "Order number of the laboratory" can optionally be used by the person working on the order can be used for their own purposes.
Exception indication
Quarter
The quarter in which the transfer was issued must be entered in the relevant field in the form "QJJ".
Begin If the doctor working on behalf of the patient does not begin his treatment until the following quarter, the issued referral slip can be used, provided that the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of entitlement to claim.
Gender
Enter the patient's gender by entering" W "or" M "in the relevant field. For patients of undetermined gender, both fields must be marked with an X.
Type of service (curative, preventive, in the case of treatment by attending physicians, conception regulation / sterilization / termination of pregnancy)
The referring contract doctor must indicate whether the order within the scope of curative care, the Prevention, the conception regulation / sterilization / termination of pregnancy or with medical treatment takes place.
Accident, consequences of accidents
The referring contract doctor must indicate if the treatment is necessary due to or as consequence of an accident so that the health insurance companies can claim costs from third parties medical care if the accident field is not ticked in the event of an accident.
Order number of the laboratory
The framed field "Order number of the laboratory" can optionally be used by the person working on the order can be used for their own purposes.
Exception indication
Quarter
The quarter in which the transfer was issued must be entered in the relevant field in the form "QJJ".
Begin If the doctor working on behalf of the patient does not begin his treatment until the following quarter, the issued referral slip can be used, provided that the insured person can present valid electronic health card at the time of treatment. If there is no personal doctor-patient contact in the following quarter, the referral slip issued can be used without renewed proof of entitlement to claim.
Gender
Enter the patient's gender by entering" W "or" M "in the relevant field. For patients of undetermined gender, both fields must be marked with an X.
Check-up of known infection
If direct or indirect detection of pathogens is commissioned as part of check-up for known infection, the field" Check-up of known infection ". In the free text field" Findings / Medication ", the facts of the matter must also be explained. Diseases that are subject to notification can be found in Section 7 of the Infection Protection Act.
Treatment according to § 116b SGB V (ASV)
In the outpatient specialist medical care (ASV) there is no referral requirement between the members of the core team The specialists to be consulted provide their services as ASV-authorized persons according to the respective n Scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is already provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in place 30 in the status field of the personal data field.
< img alt = "" src = "./ images / 94b56bd2aeae08fb117e499bd88c7800.png"> Restricted entitlement to benefits in accordance with Section 16 (3a) SGB V
Should the insured provide sample 85 (proof of If the entitlement to claim is presented when the claim is suspended in accordance with Section 16 (3a) SGB V), the referring doctor only needs to make referrals in the context of acute illnesses and pain, as well as pregnancy and maternity. The referring contract doctor indicates this by ticking the field "limited entitlement to benefits according to § 16 paragraph 3a SGB V".
Acceptance date
According to the guideline of the German Medical Association for quality assurance of medical laboratory examinations, the sender must enter the acceptance date in the appropriate field if necessary for the diagnosis of the results (form TTMMJJ ).
Check-up of known infection
If direct or indirect detection of pathogens is commissioned as part of check-up for known infection, the field" Check-up of known infection ". In the free text field" Findings / Medication ", the facts of the matter must also be explained. Diseases that are subject to notification can be found in Section 7 of the Infection Protection Act.
Treatment according to § 116b SGB V (ASV)
In the outpatient specialist medical care (ASV) there is no referral requirement between the members of the core team The specialists to be consulted provide their services as ASV-authorized persons according to the respective n Scope of treatment on referral. To do this, the field “Treat. according to § 116b SGB V “should not be ticked. The required identification on the transfer slip is already provided by specifying the ASV team number (instead of the permanent establishment number) and an additional identification in place 30 in the status field of the personal data field.
< img alt = "" src = "./ images / 94b56bd2aeae08fb117e499bd88c7800.png"> Restricted entitlement to benefits in accordance with Section 16 (3a) SGB V
Should the insured provide sample 85 (proof of If the entitlement to claim is presented when the claim is suspended in accordance with Section 16 (3a) SGB V), the referring doctor only needs to make referrals in the context of acute illnesses and pain, as well as pregnancy and maternity. The referring contract doctor indicates this by ticking the field "limited entitlement to benefits according to § 16 paragraph 3a SGB V".
Acceptance date
According to the guideline of the German Medical Association for quality assurance of medical laboratory examinations, the sender must enter the acceptance date in the appropriate field if necessary for the diagnosis of the results (form TTMMJJ ).
Acceptance time
According to the guideline of the German Medical Association for the quality assurance of medical laboratory examinations, the sender must enter the acceptance time in the appropriate field if necessary for the diagnosis of the results (form hhmm).
Urgent report transfer
In the case of an urgent transmission of findings, the referring contract doctor can mark them as such and note the telephone or fax number to which the findings are also to be sent.
Diagnosis / suspected diagnosis - findings / medication - order
The referring contract After naming the diagnosis / suspected diagnosis, if possible as an ICD code, the finding or the medication, the order services in the order field must be specifically described in terms of type and scope (stating the fee schedule item or the precise service description). The doctor performing the contract service may only perform the examinations specified in the order field. An extension of the order in terms of type or scope requires the consent of the referring contract doctor; it must be noted on the form.
Barcode for blank forms
When using the method for printing blank forms, two-dimensional barcode PDF 417 is printed using laser printer. This contains all the information on the form and can be automatically evaluated by the doctor working on the order.
Referral
The doctor performing an order is entitled to have parts of this order that he cannot perform himself performed by another doctor as an order service (referral). In this case, he must also issue referral slip according to sample 10 and provide the relevant information, in particular to take over the information of the first initiator and to indicate his doctor and establishment number in the relevant bold-framed field. “
< p> 2.png "> Acceptance timeAccording to the guideline of the German Medical Association for the quality assurance of medical laboratory examinations, the sender must enter the acceptance time in the appropriate field if necessary for the diagnosis of the results (form hhmm).
Urgent report transfer
In the case of an urgent transmission of findings, the referring contract doctor can mark them as such and note the telephone or fax number to which the findings are also to be sent.
Diagnosis / suspected diagnosis - findings / medication - order
The referring contract After naming the diagnosis / suspected diagnosis, if possible as an ICD code, the finding or the medication, the order services in the order field must be specifically described in terms of type and scope (stating the fee schedule item or the precise service description). The doctor performing the contract service may only perform the examinations specified in the order field. An extension of the order in terms of type or scope requires the consent of the referring contract doctor; it must be noted on the form.
Barcode for blank forms
When using the method for printing blank forms, two-dimensional barcode PDF 417 is printed using laser printer. This contains all the information on the form and can be automatically evaluated by the doctor working on the order.
Referral
The doctor performing an order is entitled to have parts of this order that he cannot perform himself performed by another doctor as an order service (referral). In this case, he must also issue referral slip according to sample 10 and provide the relevant information, in particular to take over the information of the first initiator and to indicate his doctor and establishment number in the relevant bold-framed field. “
< p> 2. The form explanations for sample 10A change as follows:" Sample 10A: Request form for laboratory tests in laboratory communities
A request form for laboratory examinations in laboratory communities may only be issued if the requesting contract doctor has been presented with valid electronic health card in the relevant quarter. Exceptions are permitted if e.g. the measures to be taken are urgently required or the contracting doctor who makes the request is unequivocally aware of the health insurance company.
The request form for laboratory tests in laboratory groups is divided into two parts. The upper part of the form is used for identification. The lower part is the order part. Both parts must be completed by the requesting doctor.
The following instructions must be observed when filling out or reading out the fields:
The contracting doctor making the request must indicate whether the order is in the context of curative care, prevention or treatment by an attending physician.
Accident, consequences of accidents
The contracting doctor informs the laboratory community by ticking the area of the accident if treatment is necessary due to or as result of an accident Lich is so that the health insurance companies can claim costs from third parties. It means an unnecessary financial burden on the statutory health care provider if the accident field is not ticked in the event of an accident.
Exception indication
If the prerequisites for an exception indication are met, the requesting contract doctor enters the relevant identification number (32005 - 32023) in the corresponding field.
Gender
The gender of the patient is indicated by marking the relevant field with to indicate an X. For patients of undetermined gender, both fields must be marked with an X.
Sample 10A: Request form for laboratory tests in laboratory communities
A request form for laboratory examinations in laboratory communities may only be issued if the requesting contract doctor has been presented with valid electronic health card in the relevant quarter. Exceptions are permitted if e.g. the measures to be taken are urgently required or the contracting doctor who makes the request is unequivocally aware of the health insurance company.
The request form for laboratory tests in laboratory groups is divided into two parts. The upper part of the form is used for identification. The lower part is the order part. Both parts must be completed by the requesting doctor.
The following instructions must be observed when filling out or reading out the fields:
The contracting doctor making the request must indicate whether the order is in the context of curative care, prevention or treatment by an attending physician.
Accident, consequences of accidents
The contracting doctor informs the laboratory community by ticking the area of the accident if treatment is necessary due to or as result of an accident Lich is so that the health insurance companies can claim costs from third parties. It means an unnecessary financial burden on the statutory health care provider if the accident field is not ticked in the event of an accident.
Exception indication
If the prerequisites for an exception indication are met, the requesting contract doctor enters the relevant identification number (32005 - 32023) in the corresponding field.
Gender
The gender of the patient is indicated by marking the relevant field with to indicate an X. For patients of undetermined gender, both fields must be marked with an X.
Acceptance date
The acceptance date must be entered in the corresponding field in the form DDMMYY.
Acceptance time
The acceptance time must be entered in the appropriate field in the form hhmm.
< p> Diagnoses In the diagnosis field, the laboratory community working on the order can provide the diagnosis or . To communicate suspected diagnosis and important findings / medications.
Order field
The requesting contract doctor has d Note the order services manually by means of lines in the order field. The services of the general laboratory not named in the order field are available under “Other”. The laboratory community performing the contract may only perform the tests that are specified in the order field.
Barcode for blank form printing
When using the process for blank form printing, two-dimensional PDF 417 barcode is printed using laser printer. This contains all the information on the form and can be automatically evaluated in the laboratory community. "
3. The form explanations for sample 14 change as follows:
“Erratum
In the context of 40. Amending agreement, paragraph was incorrectly positioned in the explanations on the form for sample 14. The paragraph Special feature of the regulation outside the normal case has been wrongly assigned to the point Therapy duration per session. This paragraph correctly follows the point Regulation amount. “
4. The form explanations for sample 55 change as follows:
" Sample 55: Certificate of serious chronic illness according to § 62 SGB V * 2
The certificate is required by the health insurance company if insured persons apply for reduction in the load limit for co-payments from 2% to 1% .png "> Acceptance date
The acceptance date must be entered in the corresponding field in the form DDMMYY.
Acceptance time
The acceptance time must be entered in the appropriate field in the form hhmm.
< p> Diagnoses In the diagnosis field, the laboratory community working on the order can provide the diagnosis or . To communicate suspected diagnosis and important findings / medications.
Order field
The requesting contract doctor has d Note the order services manually by means of lines in the order field. The services of the general laboratory not named in the order field are available under “Other”. The laboratory community performing the contract may only perform the tests that are specified in the order field.
Barcode for blank form printing
When using the process for blank form printing, two-dimensional PDF 417 barcode is printed using laser printer. This contains all the information on the form and can be automatically evaluated in the laboratory community. "
3. The form explanations for sample 14 change as follows:
“Erratum
In the context of 40. Amending agreement, paragraph was incorrectly positioned in the explanations on the form for sample 14. The paragraph Special feature of the regulation outside the normal case has been wrongly assigned to the point Therapy duration per session. This paragraph correctly follows the point Regulation amount. “
4. The form explanations for sample 55 change as follows:
" Sample 55: Certificate of serious chronic illness according to § 62 SGB V * 2
The certificate is required by the health insurance company if insured persons apply for reduction in the load limit for co-payments from 2% to 1% .Sample 55 is only to be issued if insured persons need this for their specific application for an exemption from co-payments. This is usually the case when insured persons submit an application for an exemption from co-payments with reduced burden limit for the first time, or if current evidence is required from the health insurance company for subsequent application. If this is the case, the health insurance company will inform the insured person when submitting the application.
Before issuing the certificate, the contract doctor should ask whether the sample is already available has been issued by another contract doctor in order to avoid multiple issuance within calendar year.
The guidelines of the Federal Joint Committee for the implementation of the regulations in § 62 SGB V for Seriously chronically ill people ("chronicler guideline") must be observed.
The following information must be taken into account when filling out the fields:
indication of the period of the / span>
Here you can specify since when ( DDMMYY) the insured person is in permanent treatment. "Long-term treatment" exists if the insured person received medical treatment for the same illness at least once quarter for at least one year prior to the issue of this certificate.
Long-term diagnoses requiring treatment
The diagnoses for which the insured person is in long-term treatment should be specified here . The diagnosis (s) are stated according to ICD-10. If there are several diagnoses that can be considered, the main diagnosis should be given first.
Continuous medical care for the above-mentioned disease is still required
Here it must be indicated whether continuous medical care (medical / psychotherapeutic treatment, drug therapy, treatment care, supply of remedies and aids) is the one previously mentioned under specified disease (s) is required.Sample 55 is only to be issued if insured persons need this for their specific application for an exemption from co-payments. This is usually the case when insured persons submit an application for an exemption from co-payments with reduced burden limit for the first time, or if current evidence is required from the health insurance company for subsequent application. If this is the case, the health insurance company will inform the insured person when submitting the application.
Before issuing the certificate, the contract doctor should ask whether the sample is already available has been issued by another contract doctor in order to avoid multiple issuance within calendar year.
The guidelines of the Federal Joint Committee for the implementation of the regulations in § 62 SGB V for Seriously chronically ill people ("chronicler guideline") must be observed.
The following information must be taken into account when filling out the fields:
indication of the period of the / span>
Here you can specify since when ( DDMMYY) the insured person is in permanent treatment. "Long-term treatment" exists if the insured person received medical treatment for the same illness at least once quarter for at least one year prior to the issue of this certificate.
Long-term diagnoses requiring treatment
The diagnoses for which the insured person is in long-term treatment should be specified here . The diagnosis (s) are stated according to ICD-10. If there are several diagnoses that can be considered, the main diagnosis should be given first.
Continuous medical care for the above-mentioned disease is still required
Here it must be indicated whether continuous medical care (medical / psychotherapeutic treatment, drug therapy, treatment care, supply of remedies and aids) is the one previously mentioned under specified disease (s) is required.This is the case if, without further treatment, life-threatening deterioration, reduction in life expectancy or permanent impairment of the quality of life can be expected according to the medical judgment. It should be stated whether and for what period of time the long-term treatment will still be required.
The back of the sample may be provided by the insured person or their / to fill out his supervisor. This is only necessary if the application for exemption from co-payments is not made solely for the insured person named on the certificate. B. jointly through the spouse. “
Article 3
Entry into force
The changes to the form explanations for sample 14 come into effect on 01.01.2017. All other changes come into effect on October 1st, 2016.
Old samples 55 must not be used up.
Berlin, August 1st, 2016
National Association of Statutory Health Insurance Physicians , Kdö.R., Berlin
GKV-Spitzenverband, Kdö.R., Berlin
Announcements
The National Association of Statutory Health Insurance Physicians, Kdö.R. , Berlin - on the one hand - and the GKV-Spitzenverband (National Association of Health Insurance Funds), Kdö.R., Berlin - on the other hand - agree the following:
6. Change to the agreement on the use of the blank form printing process for the production and printing of forms for statutory health care (Annex 2a BMV-Ä)
from October 1, 2014
Article 1
1. In the overview in section 1.4, the entry for sample 55 / E is changed as follows:
2. Number 1.2.4 changes as follows:
" The contract doctor can use samples 11 / E and 25 / E as well as the backs of samples 50 / E, 51 / E and 53 / E (50.2 / E, 51.2 / E and 53.2 / E) as blank forms. These can be attached to forms 11, 25, 50, 51, and 53, which are sent by the health insurances or the insured person to the contracted doctor and, after he has entered the requested information, should be returned to the health insurer in the original. “
3. Numbers 2.55, 2.55.1, 2.55.2, 2.55.3 and 2.55.7 are changed as follows:
" 2.55 Model 55: Certificate of serious chronic illness acc. § 62 SGB V (as of 10.2016) * 1
2.55.1 For the certification of serious chronic illness according to According to § 62 SGB V, sample 55 / E can be used in accordance with the form shown in Chapter 2.55.7.
2.55.2 Sample 55 / E is printed on security paper in DIN format A5 upright.
2.55.This is the case if, without further treatment, life-threatening deterioration, reduction in life expectancy or permanent impairment of the quality of life can be expected according to the medical judgment. It should be stated whether and for what period of time the long-term treatment will still be required.
The back of the sample may be provided by the insured person or their / to fill out his supervisor. This is only necessary if the application for exemption from co-payments is not made solely for the insured person named on the certificate. B. jointly through the spouse. “
Article 3
Entry into force
The changes to the form explanations for sample 14 come into effect on 01.01.2017. All other changes come into effect on October 1st, 2016.
Old samples 55 must not be used up.
Berlin, August 1st, 2016
National Association of Statutory Health Insurance Physicians , Kdö.R., Berlin
GKV-Spitzenverband, Kdö.R., Berlin
Announcements
The National Association of Statutory Health Insurance Physicians, Kdö.R. , Berlin - on the one hand - and the GKV-Spitzenverband (National Association of Health Insurance Funds), Kdö.R., Berlin - on the other hand - agree the following:
6. Change to the agreement on the use of the blank form printing process for the production and printing of forms for statutory health care (Annex 2a BMV-Ä)
from October 1, 2014
Article 1
1. In the overview in section 1.4, the entry for sample 55 / E is changed as follows:
2. Number 1.2.4 changes as follows:
" The contract doctor can use samples 11 / E and 25 / E as well as the backs of samples 50 / E, 51 / E and 53 / E (50.2 / E, 51.2 / E and 53.2 / E) as blank forms. These can be attached to forms 11, 25, 50, 51, and 53, which are sent by the health insurances or the insured person to the contracted doctor and, after he has entered the requested information, should be returned to the health insurer in the original. “
3. Numbers 2.55, 2.55.1, 2.55.2, 2.55.3 and 2.55.7 are changed as follows:
" 2.55 Model 55: Certificate of serious chronic illness acc. § 62 SGB V (as of 10.2016) * 1
2.55.1 For the certification of serious chronic illness according to According to § 62 SGB V, sample 55 / E can be used in accordance with the form shown in Chapter 2.55.7.
2.55.2 Sample 55 / E is printed on security paper in DIN format A5 upright.
2.55.3 The sample 55 / E is provided with barcode. The specification of the barcode can be found in the currently valid version of the "Technical Manual for Blank Form Printing".
2.55.7 Sample 55 / E
Article 2
Entry into force
The changes come into effect on October 1st, 2016.
Berlin, August 1st, 2016
National Association of Statutory Health Insurance Physicians, Kdö.R., Berlin
GKV -Spitzenverband, Kdö.R., Berlin
* 1 The table of contents changes accordingly
* 2 The table of contents changes accordingly
* 1 The table of contents changes accordingly
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