DA012 – Credit Note - Benefits in Kind (CRN)

Purpose of the SED:

The SED DA012 is used to send credit note with the withdrawn or adjusted claims for reimbursement. Credit note reduces the original claim, i.e. the claims presented in the credit note are considered as no longer valid in the original claim for reimbursement (DA010).

DA012 can be sent only to withdraw or adjust individual claims included in the original claim (DA010), DA012 has to include reference to original claim which is changed;

DA012 is issued when for example claims were included in DA010 incorrectly or the amounts of the benefits were incorrect;

No new claims can be added with the DA012, for those a new process AW_BUC_05 has to be started;

DA012 cannot be sent if the claims were already contested by the Debtor Liaison Body (Counterparty) on ‘Contestation of Individual Claim – Benefits in Kind (COC)’ DA016 SED – it is enough to accept the contestation, which means that the claims are withdrawn;

DA012 is not a reply for the ‘Contestation of Individual Claim – Benefits in Kind (COC)’ DA016 SED;

DA012 can be sent several time, each time for a new batch of the individual claims which are withdrawn or adjusted;

DA012 can be issued even after the process has been finalized and information on payment has been received.

Acronyms used in DA012:

CLA – claim for reimbursement;

CRN – credit note.

Reimbursement SEDs includes 2 parts: global and individual.

Global part of DA012 includes following mandatory fields:

Reference numbers:

“Global CLA reference Creditor Liaison Body” – a reference number of the claim specified in the DA010, which should be copied without any change;

“Global CRN reference Creditor Liaison Body” – a reference number of the credit note for the claim which allows to identify the credit note in the next steps of the exchange and in any future communication (links the SEDs). It is a unique number for given credit note and is repeated subsequently in the following SEDs at the global and at the individual level of SED.

Total number of individual credit notes – which summarizes the number of individual credit notes and should be equal to the number of repeated () individual parts;

Total amount of credit notes – which summarizes the amounts of the withdrawn or adjusted claim specified in each individual credit note;

Date of submission – with a date on which DA012 is submitted by the Creditor Liaison Body (Case Owner).

Individual part of DA012, which can be repeated (), allows to provide information about each individual claim which is being withdrawn or adjusted and includes following mandatory fields:

ID Creditor / Debtor Institution – copied from DA010 – with identification data (Institution ID, institution name) either of the institution of the place of residence / stay which provided benefits and requested reimbursement (Creditor) or the competent institution which issued entitlement document and is responsible for covering the cost of the benefits (Debtor);

References – a set of references which allows to identify the CRN on

global and individual level and connect it with the claim, including:

“Global CLA Reference Creditor Liaison Body” – a reference number of the claim specified in the DA010, which allows to link individual CRN with the original claim (DA010) and should be copied without a change;

“Global CRN Reference Creditor Liaison Body” – a reference number of the CRN copied from the global part of DA012, which allows to link the individual CRN with the global part of DA012;

“Individual CLA Number Creditor Liaison Body” – a reference number of the individual claim specified in the individual part of DA010 which allows to link the individual CRN (DA012) with individual original claim (DA010) and should be copied without a change;

“Individual CRN_ILP Number Creditor Liaison Body” – a reference number of the individual CRN which allows to identify the individual credit note in the next steps of the exchange and in any future communication (links the SEDs). It is a unique number for given individual CRN and is repeated subsequently in the following SEDs at the individual level of SED.

Person receiving benefits – copied from DA010 – information about the person who received the benefits in kind;

Details of the benefits which are to be withdrawn or adjusted (credit note benefits):

Relation to AWOD – with choice between accident at work and occupational disease;

Benefits period – the period in which the benefits were provided;

Detailed benefits amount – amount of each specific benefits, i.e. medical care, medicine, dental care, long term care;

Hospitalisation benefits – a repeatable section with hospitalisation amount and period of the hospitalisation;

Other benefits – a repeatable section with benefits amount and

possibility to describe the other benefits which does not follow under previous sections;

The amount of individual CRN - the amount of the claim which is to be withdrawn or adjusted. This amount can be either equal to the amount of the individual claim specified in DA010 or only partial if the credit note is issued only for part of the individual claim. This amount is being summarized in the Total amount credit notes in the global part.

It is not possible to add attachments to DA012.

For general remarks applicable to all the AWOD SEDs click here.

In order to see the content and explanatory notes of SED DA012 please click here.