Sonderbeleg

The Sonderbeleg is the document that turns a completed service into a claim. A pharmazeutische Dienstleistung is not billed the way a package of medicine is billed, because there is no Packung, no article number and no prescription to price. The claim uses a document of its own that names the service instead of a product.

What goes on it is modest and fixed:

• The pharmacy identifies itself by its own Institutionskennzeichen.
• The insured person is identified from the data on the Krankenversichertenkarte.
• The service is identified by the code of the specific pharmaceutical service performed.
• The date of performance is entered on the document.
• The insured person confirms with a signature that the service was actually delivered.

Nothing clinical belongs on the Sonderbeleg, because the substance of the service stays in the pharmacy records. Where a result is handed to the person it goes on an Informationsbogen zur Ergebnisdokumentation rather than on the billing document.

From the pharmacy the completed Beleg goes to the Apothekenrechenzentrum, which gathers the claims of that pharmacy and settles them against the payer side. The rhythm is quarterly rather than monthly, so services performed in one quarter are submitted together for that quarter and the money arrives a long way behind the appointment.

The practical consequence is unglamorous, because a Beleg with a missing signature or a wrong date is only discovered when the quarter is prepared, by which time the person who was vaccinated or advised is weeks gone. So the check belongs on the day of the service rather than at the end of the quarter.

One confusion is worth clearing up carefully, because it costs pharmacies real planning time. This route exists only for the defined pharmaceutical services, the list of them is closed, and each entry on it has its own protocol and its own fee. A diagnostic service the customer pays for is not on the list, and it does not become claimable by being documented well.

A self pay diagnostic service is invoiced to the customer directly, and the paperwork for it is a Behandlungsvertrag and an invoice rather than a Beleg for the settlement house. Pharmacies building a blood draw offer sometimes assume the two systems meet somewhere further along, but they do not meet at any point.