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Overview of LiMed functionality

What is LiMed?​

LiMed is a Switzerland specific invoicing methodology for medical means and applicances. Read here introduction to learn more about LiMed.

Concept​

To understand how the system works based on today's logik and knowledge, the diagram below can help and the concept must be assimilated.

A MiGeL entity (material, means,item...) should be invoiced to the insurance for a max amount defined by the FOPH.(BAG, OFSP). Some limitations and annual flat rate can be decided. Any remaining amount will be borne by the beneficiary. The insurances expect a correct LiMed No. or the invoice will be rejected and the refund will not be issued. This means entity must be identified by a specific "LiMed" number. This number is based on the following scheme PG.Cat.SubCat1.xx.posNo : 

- Product group
- Category
- Sub-category 1
- xx base on following sub-categories (from 2 to 5)
- Position Number

For example: LiMed No. for the "Insulin Pump system" is 03.02.01.00.2.

So the structure is:

- Product Group 03 : "Application means"
- Category 02      : "insulin pump" 
- Sub-category 1   : empty
- following sub-cat: empty
- Position         : "2"
Caution

With E-Care, you will invoice HC Service, but a service is not one-one linked to a LiMed No., so it can have different LiMed No. depending of the illness of the beneficiary. Therefore, to catch the correct LiMed No., the number is entered on the beneficiary for each pair Product Group/Category relating to him.

The consumption is managed by external tools (i.e Care-Coach) and will be imported in E-Care. The import must indicate at least a Beneficiary Code, a Service Code a Consumption Date and a Quantity.

The corresponding HC Service is found and the value entered in the LiMed No. fields is used to either to use the one-one LiMed No. or find the Product group and Category, depeding of the Limed Familysetting.

If necessary, the Beneficiary is selected and his LiMed Setup parsed to find the correct LiMed No. for the related Product Group and Category.

Setup​

First you must import the actual LiMed list in Excel Format from the governement (FOPH) on the following link (state sept. 2023) download

To import FOPH list:​

go to the menu

  • Ambulatory
  • Ambulatory Configuration
  • Limed item FOPH
  • Action -> Import
Info

If an item already exists, a new price line will be created and the old one retained for historical purposes.Once imported, on this page you can check the max prices and the service text.

To setup the Beneficiary​

go to the menu

  • Care
  • Beneficiary list -> Select the beneficiary concerned
  • Care
  • Limed Setup

Beneficiary Limed Setup fields​

Short explanation of the setup fields:

Limed Setup Fields
> Limed Type : chose if it is a one-one relation with item or based on a Product Group/Category relation
> Service Code : Select either the Groupe and Category or the item no.
> Limed Item Code : select the LiMed Nr. from the list or enter the value
> Start Date : the start date of validity for this line
> End Date : the end of validity for this line
> Certificate : If selected, the max amount per yer may be exeeded
> Invoicing other institution : the amount invoiced in previous institution for the current year

To setup the HC Service​

Find more on HC Service under the fields and Ambulatory Tab for LiMed.

Entity Relationship Diagram​

Entities are summarized to the relevant fields.

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