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circolare numero 161 del 22 12 2011 allegato n 1 by 6Z5NvUA

VIEWS: 15 PAGES: 5

									                                                                                                                                                                           Upd. 2/9/2012
                                                                        ARTICLE IN            ARTICLE IN                               DESCRIPTION OF
             BUSINESS FLOW              SEDs                Renumbe       BASIC             IMPLEMENTING   EQUIVALENT                  BUSINESS FLOW                          REMARKS
 SECTOR
             NUMBER + NAME          NUMBER + NAME           red SEDs   REGULATION            REGULATION      E-FORM                 (meaning + purpose)/ OF                   ON SEDs
                                                                          883/04                987/09                            PARTICULAR SED IN THE BF
                                  S071 - Request for
             F-S001 - Entitlement
                                  Entitlement Document-                                                                          Member state of residence requests
 Sickness   Document - Residence                              S071     17, 22, 24, 25, 26        24              E107
                                  Residence                                                                                           entitlement document
                 Outside CS
                                   S072 - Entitlement                                                        part A E106,         Institution in competent state sends
                                   Document - Residence       S072     17, 22, 24, 25, 26        24          E109, E120,           entitlement document in case that
                                                                                                                 E121                   person is entitled for that
                                   S073 - Information of
                                                                                                                                                                               It is also
                                   Registration -
                                                                                                                                                                           necessary to
                                   Residence                                                                 part B E106,
                                                                                                                                Institution in state of residence informs fill in part A of
                                                              S073     17, 22, 24, 25, 26        24          E109, E120
                                                                                                                                          CI about registration                 E106 -
                                                                                                                E121
                                                                                                                                                                            idetification
                                                                                                                                                                          data of person
                                   S050 - Dispute
                                   Registration Date -
                                   Residence                                                                                     CI informs institution that they do not
                                                              S050     17, 22, 24, 25, 26        24               ---           agree with date of registration provided
                                                                                                                                 by institution of the place of residence



            F-S002 - Register      S073 - Information of
  This flow
            (Residence Outside     Registration -
begins when                                                                                                                                                                    It is also
            CS with Entitlement    Residence
   person                                                                                                                                                                  necessary to
            Document Available)                                                                             part B of E106,
 concerned                                                                                                                      Institution in state of residence informs fill in part A of
                                                              S073     17, 22, 24, 25, 26        24         E109, E120 or
  presents                                                                                                                      competent institution about registration        E106 -
                                                                                                                 E121
  portable                                                                                                                                                                  idetification
 document                                                                                                                                                                 data of person
     S1
                                   S050 - Dispute                                                                                 CI informs institution of the place of
                                   Registration Date -                                                                           residence that they do not agree with
                                                              S050     17, 22, 24, 25, 26        24               ---
                                   Residence                                                                                        date of registration provided by
                                                                                                                                  institution of the place of residence

            F-S003 - Change or     S016 - Change or
                                                                                                                                                                           We assume
            Cancellation of        Cancellation of
                                                                                                                                                                             that the
            Entitlement Document   Entitlement Document
                                                                                                                                                                           change or
                                                                                                                                                                         cancellation of
                                                                                                                E108              CI informs institution of the place of
                                                                                                                                                                               the
                                                              S016     17, 22, 24, 25, 26        24         (cancellation),     residence about cancellation or change
                                                                                                                                                                           entitlement
                                                                                                            E001 (change)               of entitlement document
                                                                                                                                                                          document is
                                                                                                                                                                            done per
                                                                                                                                                                            individual
                                                                                                                                                                         family member
                                   S017 - Reply to
                                   Change or Cancellation                                                       E108               Reply to information concerning
                                   of Entitlement             S017     17, 22, 24, 25, 26        24         (cancellation),      change or cancellation of entitlement
                                   Document                                                                 E001 (change)                     document

                                   S050 - Dispute
                                   Registration Date -                                                                                                                    SEDs S017
                                   Residence                                                                                                                             and S050 are
                                                                                                                                   Institution of the place of residence
                                                                                                                                                                              two
                                                              S050     17, 22, 24, 25, 26        24               ---            informs CI that they do not agree with
                                                                                                                                                                         possibilites for
                                                                                                                                      date mentioned in SED S016
                                                                                                                                                                           replying to
                                                                                                                                                                             S016.


            F-S004 - Change or     S018 - Change or
            Cancellation of        Cancellation of
                                                                                                                E108              Institution of the place of residence
            Registration           Registration
                                                              S018     17, 22, 24, 25, 26        24         (cancellation),         informs CI about cancellation or
                                                                                                            E001 (change)                 change of registration


                                   S019 - Reply to
                                                                                                                E108
                                   Change or Cancellation                                                                          Reply to information concerning
                                                              S019     17, 22, 24, 25, 26        24         (cancellation),
                                   of Registration                                                                               change or cancellation of registration
                                                                                                            E001 (change)
                                   S050 - Dispute
                                   Registration Date -                                                                                                                        SEDs S019
                                   Residence                                                                                                                                 and S050 are
                                                                                                                                  CI informs institution of the place of
                                                                                                                                                                                  two
                                                              S050     17, 22, 24, 25, 26        24               ---            residence that they do not agree with
                                                                                                                                                                             possibilites for
                                                                                                                                        date mentioned in S018
                                                                                                                                                                               replying to
                                                                                                                                                                                 S018.



            F-S005 - Necessary     S044 - Request for
            Treatment in MS of     Entitlement Document -
            Stay - Request for     Stay (European Health                                                                        Institution of the place of stay requests
            Entitlement Document   Insurance Card or          S044            19                 25         Part A of E107        entitlement document for benefits in
            (European Health       Replacement form)                                                                                 kind in case of temporary stay
            Insurance Card or
            Replacement Form)

                                   S045 - Entitlement
                                   Document - Stay                                                           Replacement
                                                                                                                                   CI sends entitlement document
                                   (European Health                                                        form (or part B of
                                                              S045            19                 25                               (Replacement form) or replies that
                                   Insurance Card or                                                        E107 if there is
                                                                                                                                   person concerned is not entitled
                                   Replacement form)                                                        no entitlement)
                                                                                                                                            Upd. 2/9/2012


F-S006 - Necessary  S067 - Request for
Treatment -         Reimbursement Rates -                                                         CI requests reimbursement rates in
                                                      S067   19, 27   25         E126
Reimbursement Rates Stay                                                                         case that treatment was paied by cash

                           S068 - Reply                                                            Institution of the place of treatment
                           Reimbursement Rates-       S068   19, 27   25         E126                  informs CI about applicable
                           Stay                                                                             reimbursement rates

F-S007 - Scheduled         S014 - Request
Treatment - Information    Information as if
on Coverage of             Treatment is covered in                                                  CI asks institution in the state of
Specific Benefit in Kind   MS of Stay - Scheduled                                                possible scheduled treatment whether
                                                      S014    20      26           ---
                           Treatment                                                              the particular treatment is covered in
                                                                                                                 that state


                           S015 - Information on
                           coverage of Treatment -                                               Reply to request concerning coverage
                                                      S015    20      26           ---
                           Scheduled Treatment                                                           of particular treatment


F-S008 Scheduled           S009 - Request for
treatment - Request        Entitlement Document -
Entitlement Document       Scheduled Treatment                                                    Member state of residence requests
                                                      S009    20      26         E107
in MS of Stay              outside CMS/RMS                                                             entitlement document
(Residence not in
CMS)
                           S075 - Request
                                                                                                   Request additional info - scheduled
                           additional Info -
                                                      S075    20      26                         treatment outside CS and outside state
                           Scheduled Treatment
                                                                                                              of residence
                           outside CMS/RMS
                           S076 Reply to Request
                           additional info -                                                       Reply to Request additional info -
                           Scheduled Treatment        S076    20      26                          scheduled treatment outside CS and
                           outside CMS/RMS                                                            outside state of residence

                           S010 - Entitlement                                                                                                  In this case
                           Document - Scheduled                                                                                                  portable
                           Treatment outside                                E112 (or part B                                                   document S2
                                                                                                   CI sends entitlement document for
                           CMS/RMS                    S010    20      26   of E107 if there is                                                  should be
                                                                                                         scheduled treatment
                                                                            no entitlement)                                                     sent to the
                                                                                                                                                  person
                                                                                                                                                concerned

F-S009 - Scheduled         S035 - Request for
treatment - Request        Extension of                                                          Institution of the place of state requests
extension of               Entitlement Document -     S035    20      26           ---            extension of entitlement document for
authorization in MS of     Scheduled Treatment                                                              scheduled treatment
Stay
                           S036 -
                           Acknowledgement of
                           Request for Extension                                                   CI informs institution of the place of
                           of Entitlement             S036    20      26           ---              treatment that they received their
                           Document - Scheduled                                                            request for extension
                           Treatment

                           S037 - Reply to
                           Request for Extension
                           of Entitlement                                                          CI informs institution of the place of
                           Document - Scheduled                                                       treatment about their decision
                                                      S037    20      26           ---
                           Treatment                                                               concerning extension of entitlement
                                                                                                    document for scheduled treatment



F-S011 - Urgent Vitally    S011 - Information of
                                                                                                                                          E112/paper
Necessary treatment        Authorisation - Urgent
                                                                                                                                         SED S010 or
(UrgAut) - Request for     Vitally Necessary
                                                                                                                                            portable
Authorisation in MS of     Treatment
                                                                                                                                         document S2
stay (Residence not in
                                                                                                   Institution of the place of residence   should be
CMS)
                                                      S011    20      26           ---           informs CI that they granted scheduled issued as an
                                                                                                         treatment of behalf of CI         entitlement
                                                                                                                                         document for
                                                                                                                                          institution of
                                                                                                                                          the place of
                                                                                                                                               stay
                           S012 -
                           Acknowledgement of
                           Receipt for Information                                                 CI informs institution of the place of
                           of Authorisation -                                                       residence that they received their
                           Urgent Vitally             S012    20      26           ---
                                                                                                     information concerning granted
                           Necessary Treatment                                                             scheduled treatment



                           S075 - Request
                           additional Info - Urgent
                           Vitally Necessary                                                       Request additional info - scheduled
                           Treatment                  S075    20      26                         treatment outside CS and outside state
                                                                                                              of residence


                           S076 Reply to Request
                           additional info - Urgent                                                Reply to Request additional info -
                           Vitally Necessary          S076    20      26                          scheduled treatment outside CS and
                           Treatment                                                                  outside state of residence
                                                                                                                                               Upd. 2/9/2012
                          S013
                       Notification of Payment                                                          CI informs institution of the place of
                       - Urgent Vitally           S013   20           26                              stay that bill can be sent directly to the
                       Necessary Treatment                                                                                CI



F-S012 - Cash Benefits S055 - Application for
- Application          Cash Benefits                                                                         Institution in MS of place of
                                                                                                       residence/stay transfers the medical
                                                                                                      certificate related to incapacity for work
                                                  S055   21      27(3)(8)(10)            E 115           of the person concerned to the CI
                                                                                                         when the doctor in MS of place of
                                                                                                       residence/stay doesn’t issue medical
                                                                                                                       certificates



F-S013 - Cash Benefits S063 - Request for
                                                                                                      CI requests institution in MS of place of
- Administrative Check Administrative Check
                                                                                                       residence/stay to carry out a medical
or Medical Examination or Medical Examination     S063   21   27(5)(10), 87(1)(3)        E 117
                                                                                                      examination or an administrative check
                                                                                                              of the insured person
                       S065 - Information
                                                                                                        Institution of place of residence/stay
                       about Costs of
                                                                                                      informs the CI about estimated costs of
                       Administrative Check       S065   21     27(5)(10), 87              '---
                                                                                                         an administrative check or medical
                       or Medical Examination
                                                                                                                      examination
                       S066 - AApproval or                                                              CI informs the institution of place of
                       not of Administrative                                                          residence/stay about approval or not of
                       Check or Medical           S066   21     27(5)(10), 87              '---         the estimated costs of the required
                       Examination                                                                        administrative check or medical
                                                                                                                    examination
                       S064 - Reply to
                                                                                    E213 for medical
                       Request for
                                                                                    exam. in case of
                       Administrative Check
                                                                                      invalidity and
                       or Medical Examination                                                              Institution in MS of place of
                                                                                    E116 for medical
                                                                                                      residence/stay informs CI about result
                                                                                    exam. In case of
                                                                                                      of an administrative check or medical
                                                  S064   21   27(5)(10), 87(1)(3)     cash benefits
                                                                                                     examination                         BF-
                                                                                        related to
                                                                                                        S013 is followed by BF-H005, if
                                                                                      incapacity for
                                                                                                                     necessary
                                                                                     work , E215 for
                                                                                     administrative
                                                                                          check


F-S014 - Cash Benefits S046 - Information on
- Information on       Payment or Not of                                                               CI informs institution in MS of place of
Payment                Cash Benefits              S046   21      27(7)(9)(10)        E 117+ E 118     residence/stay about payment or not of
                                                                                                                    cash benefits

                       S047 - Information on
                                                                                                      CI informs institution in MS of place of
                       End of Incapacity for
                                                                                                          residence/stay about the end of
                       Work                       S047   21      27(7)(9)(10)            E 118
                                                                                                         incapacity for work of the person
                                                                                                                     concerned


F-S015 - Long Term     S056 - Notification
                                                                                                      Member state of residence informs CI
Cash Benefits -        Application for Cash
                                                  S056   21           28                   ---         about application for cash benefits -
Application            Benefits - Long Term
                                                                                                                    long term
                       S057 -
                       Acknowledgement for                                                            CI informs member state of residence
                       Application for Cash       S057   21           28                   ---
                                                                                                              that they received claim
                       Benefits - Long Term


F-S016 Long Term       S061 - Request for
Cash Benefits -        medical examination -                                                          CI requests member state of residence
                                                  S061   21           28                   ---
Medical Examination    Long term                                                                             for medical examination

                       S062 - Reply of
                                                                                                      Member state of residence informs CI
                       medical examination -      S062   21           28                   ---
                                                                                                         about medical examination
                       Long term

F-S017 - Long Term     S001 - Information of
                                                                                                      CI informs the institution of the place of
Cash Benefits -        Payment of Cash
                                                  S001   34           30                   ---        residence or stay about the payment of
Information on         Benefits - Long term
                                                                                                            long-term care cash benefits
Payment
                       S002 -
                       Acknowledgement for                                                                Institution of the place of stay or
                       reception of Information                                                       residence informs CI that they received
                                                  S002   34           30                   ---
                       of Payment of Cash                                                               information of payment of long term
                       Benefits - Long term                                                                          cash benefits

                       S003 - Information of
                                                                                                      Institution of the place of residence or
                       Reimbursement Rates -
                                                                                                       stay informs CI about any long-term
                       Long term
                                                                                                       care benefit in kind intended for the
                                                  S003   34           30                   ---
                                                                                                      same purpose which it grants under its
                                                                                                     legislation to the person concerned and
                                                                                                           of the rate of reimbursement.
                       S004 -
                       Acknowledgement for
                                                                                                        Acknowledgement that information
                       reception of Information
                                                  S004   34           30                   --          concerning reimbursement rates has
                       of Reimbursement
                                                                                                                 been received
                       Rates - Long term

                       S005 - Information of                                                            Information on change in the rate of
                       Change in                                                                      reimbursement/change in the national
                                                  S005   34           30                   ---
                       Reimbursement Rates -                                                           legislation or end of payment of long-
                       Long term                                                                                    term benefits
                                                                                                                                                  Upd. 2/9/2012



F-S018 - Request the S006 - Request for                                                                CI Requests the information
Entitlement Document - Information of Status -                                                         concerning the person’s former status
Former Frontier Worker Former Frontier Worker     S006    28             29                ---         as frontier worker
(FFW)

                        S007 - Information of
                                                                                                        Reply to the CI´s request concerning
                        Status - Former           S007    28             29                ---
                                                                                                                        status
                        Frontier Worker
                        S008 - Entitlement                                                                CI sends information concerning
                        Document - Former         S008    28             29                ---           entitlement (entitled or not) of the
                        Frontier Worker                                                                 person concerned to benefits in kind
                        S077 - Cancellation of
                                                                                                       Cancellation of entitlement document -
                        entitlement document -    S077    28             29                ---
                                                                                                               fromer frontier worker
                        Former Frontier Worker


F-S019 - Actual Cost    S080 - Claim for
                                                                                                       Creditor institution claims medical costs
Claim - Benefit in Kind Reimbursement - Kind      S080   35, 41     62,66(1),67           E125
                                                                                                                  on debtor institution
(Kind)
                        S081 -
                        Acknowledgement of
                                                                                                          Debtor institution informs creditor
                        Claim for                 S081   35.41      62,66(1),67            ---
                                                                                                       institution that they received their claim
                        Reimbursement -Kind

                        S083 - Credit Note -                                                             Creditor institution submits a credit
                                                  S083   35.41      62,66(1),67           E125
                        Kind                                                                                 note to the debtor institution
                        S084 -                                                                            Debtor institution informs creditor
                        Acknowledgement of        S084   35.41      62,66(1),67            ---          institution that they received a credit
                        Credit Note - Kind                                                                                 note
                        S085 - Information on
                                                                                                        Proposal for down payment by debtor
                        Down Payments - Kind      S085   35.41      62,66(1),67            ---
                                                                                                                      institution
                        S086 - Reply on
                                                                                                         Creditor institution either accepts or
                        Information on Down       S086   35.41      62,66(1),67
                                                                                                             refuses the downpayment
                        Payments
                        S087 - Contestation of
                                                                                                        Debtor instution contests one single
                        Individual Claim - Kind   S087   35.41      62,66(1),67            ---
                                                                                                                        claim
                        S088 - Reply on
                                                                                                        Reply to contestation of single claim
                        Contestation of
                                                  S088   35.41      62,66(1),67            ---           (either cancellation of this claim or
                        Individual Claim - Kind
                                                                                                                   additional info)
                        S089 - Information on                                                             Debtor institution informs creditor
                        Payment of single claim   S089   35.41      62,66(1),67            ---           institution about payment of single
                        - Kind                                                                                           claim
                        S082 - Information on
                        Final Settlement - Kind   S082   35.41    62,66(1),67,68(1)        ---         Information that whole claim is settled


F-S021 - Inventory of   S090 - Inventory of
                                                                                                           Creditor instution informs debtor
Months (Fixed           Months related to
                                                  S090    35       64,65,66(1),67         E127           institution about number of claimed
Amounts)                reimbursement of -
                                                                                                                        months
                        Fixed Amounts
                        S091 -
                                                                                                          Debtor institution informs creditor
                        Acknowledgement of
                                                  S091    35       64,65,66(1),67                         institution that they received their
                        Inventories of Months -
                                                                                                                        inventory
                        Fixed Amounts
                        S092 - Credit Note of
                                                                                                         Creditor institution submits a credit
                        Months - Fixed            S092    35       64,65,66(1),67
                                                                                                                    note of months
                        Amounts
                        S093 -
                                                                                                          Debtor institution informs creditor
                        Acknowledgment of
                                                  S093    35       64,65,66(1),67                      institution that they received their credit
                        Credit Note of Months -
                                                                                                                           note
                        Fixed Amounts
                        S094 - Contestation of
                                                                                                          Debtor institution informs creditor
                        inventories of months
                                                                                                         institution about their agreement or
                        concerning one person -   S094    35       64,65,66(1),67          ---
                                                                                                         objections to inventory of months or
                        Fixed Amounts
                                                                                                                     asks more info
                        S103 - Reply on
                        contestation of                                                                Creditor institution accept contestation
                                                  S103    35       64,65,66(1),67
                        inventory of months -                                                             or gives additional information
                        Fixed Amounts
                        S095 - Claim for
                                                                                        letter with
                        reimbursement of fixed                                                             Creditor institution claims fixed
                                                  S095    35       64,65,66(1),67     calculation of
                        amounts - Fixed                                                                    amounts on debtor institution
                                                                                           claim
                        Amounts
                        S096 -
                        Acknowledgement of
                                                                                                          Debtor institution informs creditor
                        claim for
                                                  S096    35       64,65,66(1),67                      institution that they received a claim for
                        reimbursement of fixed
                                                                                                           reimbursement of fixed amounts
                        amounts - Fixed
                        Amounts
                        S097 - Information on
                        Down Payments of                                                                Proposal for down payment by debtor
                                                  S097    35       64,65,66(1),68
                        Fixed amounts - Fixed                                                                         institution
                        Amounts
                        S098 - Reply on
                        Information on Down
                                                                                                         Creditor institution either accepts or
                        Payments of Fixed         S098    35       64,65,66(1),69
                                                                                                             refuses the downpayment
                        Amounts - Fixed
                        Amounts
                        S099 - Contestation of
                        Global Claim - Fixed      S099    35       64,65,66(1),70                      Debtor instution contests a global claim
                        Amounts
                                                                                                                                             Upd. 2/9/2012




                          S100 - Reply on
                          Contestation of Global
                                                     S100   35    64,65,66(1),71                   Reply to contestation of global claim
                          Claim - Fixed Amounts

                          S101 - Information on
                                                                                                     Debtor institution informs creditor
                          Payment of Individual
                                                     S101   35    64,65,66(1),67       ---          institution about payment of single
                          claim - Fixed Amounts
                                                                                                                    claim
                          S102 - Information on
                          Final Settlement - Fixed   S102   35    64,65,66(1),67       ---        Information that whole claim is settled
                          Amounts

F-S022 - Interest Claim S026 - Claim Interest                                                        Creditor institution informs debtor
on Late Payment         on Late Payment -            S026   ---        68              ---        institution about claims for interest due
                        Interest                                                                               to late payment
                        S027 -
                                                                                                     Debtor institution informs creditor
                        Acknowledgement of
                                                     S027   ---        68              ---           institution that they have received
                        claim interest on late
                                                                                                  claims for interest due to late payment
                        payment - Interest
                        S028 - Credit Note                                                          Creditor institution submits a credit
                        Interest on Late             S028   ---        68              ---          note on late payment to the debtor
                        Payment - Interest                                                                        institution
                        S029 -
                        Acknowledgement of                                                           Debtor institution informs creditor
                        Credit Note Interest on      S029   ---        68              ---         institution that they have received a
                        Late Payment - Interest                                                         credit note on late payment

                          S030 - Contestation of
                          Claim Interest on Late                                                     Debtor instution contests a claim
                                                     S030   ---        68              ---
                          Payment - Interest                                                            interest on late payment

                          S031 - Reply to
                                                                                                  Creditor institution accept contestation
                          Contestation of Claim
                                                     S031   ---        68              ---            or gives additional information
                          Interest on Late
                                                                                                     concerning payment of interests
                          Payment - Interest
                          S032 - Information on                                                     Information that interest has been
                                                     S032   ---        68              ---
                          payment - Interest                                                                      payed

F-S023 - Refund of        S051 - Request Refund
Overpayment               of Overpayment -                                                          One institution requests refund of
                                                     S051              ---             ---
                          Overpayment                                                               overpayment on second institution

                          S052 -
                          Acknowledgement of                                                       Institution informs sending institution
                          Request of Refund of       S052              ---             ---           that they have received a request
                          Overpayment -                                                                     refund of overpayment
                          Overpayment
                          S053 - Reply to
                          Request of                                                                 Requested institution informs first
                                                     S053              ---             ---
                          Overpayment -                                                                institution about their opinion
                          Overpayment
                          S054 - Information on
                          Refund of                                                                 Information that overpayment was
                                                     S054              ---             ---
                          Overpayment -                                                                          refunded
                          Overpayment

F-S024 - Aggregation      S040 - Request for                                                          The applicant institution asks the
of Periods - Insurance    periods - Insurance risk                                                requested institution for confirmation of
risk type: sickness and   type: sickness and                                                           relevant periods of insurance,
maternity                 maternity                         6         12 (1)       E 104 part A       employment, self-employment or
                                                                                                    residence completed by the person
                                                                                                     concerned under legislation of this
                                                                                                               latter institution
                          S041 - Reply to request                                                  The requested institution informs the
                          for periods - insurance                                                   applicant institution that the person
                          risk type: sickness and           6         12 (1)       E 104 part B   concerned either completed no periods
                          maternity                                                                 under its legislation or confirms the
                                                                                                              relevant periods

								
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