Service provider group key
Every price agreement in the German healthcare system between the health insurance companies and the service providers is assigned a unique service provider group code (LEGS) . The seven-digit key consists of the account code ( AC) and the tariff code (TK) of the price agreement.
Since 2004, the German statutory health insurance modernization law has obligated all service providers in the health care system to bill the health insurance companies electronically . While the contract doctors and contract psychotherapists ensure this via the statutory health insurance associations, providers without a professional association must ensure the provision and transmission of the data themselves. This affects masseurs , physiotherapists , speech therapists , occupational therapists , podiatrists , etc. They contain specific regulationsGuidelines of the central associations of the health insurance companies according to § 302 Abs. 2 SGB V on the form and content of the billing procedure with other service providers as well as with midwives and obstetricians (§ 301a SGB V) .
Corresponding unique item numbers are also specified for the services in all price agreements. If a LEGS is sent in the course of billing for which an item to be billed has not been specified, the service will not be paid and the invoice will be rejected or the amount will be reduced.
Billing code
The billing code is a two-digit number describing the occupational group or type of service. It is communicated to the service provider with his approval or recognition by the sponsor or the recognizing association (e.g. in disabled sports by the respective national association). The ACs applicable to the respective occupational groups are set out in the key indexes of the special parts of the Social Code (SGB) (e.g. in Section 105 SGB XI, Annex 3).
Tariff indicator
The tariff code is a five-digit number to designate the price agreement. The first two digits indicate the scope of the contract, the last three digits indicate the current contract number. The type of assignment of the tariff labels is not regulated and is at the discretion of the issuing cost bearer.
example
LEGS 2213700 says
- the AC 22 for "physiotherapists and physiotherapists"
- 13 in TK for the country code of all price agreements in Saxony
- 700 in the TK for the contract number