SGK and Medula Processes: Overview

Medula is the system that enables the electronic execution of healthcare service processes between SGK and healthcare institutions. The SGK billing process consists of interconnected steps such as authorization, service registration, and billing. This guide aims to clarify the process in general terms; the final application should always be evaluated according to current regulations and the institution's processes.

Information: This content is for general informational purposes and does not constitute a legal interpretation. SGK rejection codes and billing rules may change over time.

What is Medula and what does it do?

Medula is the system that facilitates the electronic sharing of records related to healthcare services with SGK. Many steps can progress through this system, from patient application to service registration and billing.

General flow of the SGK billing process

In general terms, the process includes the following steps:

1. Application and authorization: Inquiry of the patient's eligibility and obtaining authorization.
2. Service registration: Recording the provided healthcare services in the system.
3. Billing period: Compiling records on a period basis.
4. Invoice submission and evaluation: Sending and reviewing the invoice.

The details of each step may vary according to the type of service, specialty, and current regulations.

Concepts of authorization and service registration

Authorization means the approval of a healthcare service from the perspective of eligibility before it is provided. Service registration is the entry of the provided procedures into the system. Proper execution of these two steps plays an important role in the healthy progression of the billing process.

Key points to consider during the billing period

Commonly mentioned points in practice include the completeness of records, service-diagnosis compatibility, correct interpretation of the SUT scope, and conducting checks before the period closure. These points are general in nature; each institution's processes may differ.

Connection of the process with HBYS

HBYS serves as a bridge in transferring service records and billing information to Medula processes. Proper structuring of this connection can reduce repetitive processes and increase the visibility of the process.

For a decision support approach aimed at making the billing process more visible and analyzable, you can check the SGK & Invoice Control Approach page.