Dental care

The health care provider:

1. checks the validity of the insurance cover and the amount of the balance of the assumed payment obligation for the calendar year before transmitting the data via X-tee
2. only lists the services for which the Health Insurance Fund pays on the invoice sent to the Health Insurance Fund
3. submits the invoice on the day of service provision via the X-tee data exchange layer for information systems
4. ensures that the medical invoice number combination is unique for at least three calendar years
5. can view the summary invoices and their contents using their software
6. can check the dental care benefit limit, transmit data on reimbursable services, and monitor summary information on submitted invoices by using the freeware Misp portal to transmit data on reimbursable dental care services

The Health Insurance Fund:

1. settles the invoices for correctly submitted adult dental care services no less than once a week
2. makes payments on the basis of a summary invoice to the health care provider to the bank account indicated in the contract (at a credit institution in the Republic of Estonia) within 20 calendar days at the latest

We ask the health care provider to make sure that the information on the invoice is correct and in accordance with the terms and conditions of the service before submitting the invoice.
 

Amendments to incorrectly submitted invoices will only be made on the basis of a written application by the health care provider. Please send the digitally signed application by email to info [at] tervisekassa.ee.

An application for the cancellation/crediting of an invoice must include:

• the details (name, address, registration number) of the institution that submitted the invoice;
• the name and personal identification code of the person;
• invoice number;
• date of the invoice;
• the reason for the cancellation;
• the amount to be reimbursed by the Health Insurance Fund;
• a reference to the summary invoice (if the invoice was part of a summary invoice);
• confirmation that the health care provider has informed the person of the cancellation.

Application form to be submitted to the Health Insurance Fund: application for cancellation/crediting (in Estonian).

After the cancellation/crediting of the invoice by the Health Insurance Fund, the Health Insurance Fund will inform the health care provider of the possibility to submit a new invoice.
 

Contracted service providers should know the following aspects.

1. The exchange of information for and paying of the in-kind benefit is done electronically through the software used by dental care providers.
2. Before providing a service to a person, the service provider can verify whether the person has health insurance, as well as check the limit of the benefit (60 or 105 euros) and the balance of the benefit in the Health Insurance Fund system.
3. Some necessary services provided to patients are reimbursed by the Health Insurance Fund, some are not.
4. After the services have been provided, the provider submits the invoice electronically to the Health Insurance Fund via its software (the provider must be authenticated to X-tee using an ID card or similar (secure server)). If the visit includes both services reimbursed by the Health Insurance Fund and services that are fully paid, the invoice submitted to the Health Insurance Fund must include all the services for which the Health Insurance Fund will pay, indicating the full cost of each service.
5. If the benefit limit was not checked before the provision of the service, it will be checked during the payment process. The system will then display the amount paid for the person, taking into account the limit and the prices of the services in the price list of the Health Insurance Fund, as well as the number of services.
6. The invoice is then submitted to the Health Insurance Fund and the person pays the difference between the total amount of the invoice and the amount paid by the Health Insurance Fund.
7. The Health Insurance Fund will pay the service provider on the basis of the invoice submitted by the service provider and up to the amount of the reimbursable amount shown on the invoice.