eAttest, eFact and eAgreement: how do they differ?
An eAttest sends the certificate of care provided electronically to the health insurance fund (mutualité), an eFact sends your invoice straight to the fund under the third-party payment scheme (tiers payant), and an eAgreement lets you request the medical adviser's approval online. Three MyCareNet services, each covering a different step in your admin as a physiotherapist. From 1 January 2027, all three are required by law. This article explains how they differ and when to use which.
What is an eAttest?
The eAttest is the digital successor to the paper certificate of care provided. Your patient pays you for the full treatment, just like before. The only difference is that your patient no longer goes home with a paper slip: your software sends the certificate straight to the health insurance fund through MyCareNet.
The fund processes the certificate automatically and pays the refund into your patient's account. No more ordering certificate pads, nothing left lying on a kitchen table for months, no more refunds that get lost.
So you use the eAttest when your patient pays you and gets reimbursed afterwards. How this digital highway works exactly is explained in our guide to eHealth and MyCareNet.
What is eFact?
With eFact you invoice the health insurance fund directly under the third-party payment scheme. At the practice, your patient only pays the patient co-payment and any supplement. You claim the rest of the fee from the fund electronically.
Since 1 October 2015, every physiotherapist has been allowed to apply the third-party payment scheme to all patients, without any prior formalities. It is not mandatory: you decide per patient whether to use eFact. For patients on a tight budget or facing a long course of treatment, it makes a world of difference.
A correct eFact submission is usually paid within a few weeks. Good software keeps track for you of which submissions were accepted, rejected or are still in progress.
What is an eAgreement?
An eAgreement is the electronic request for approval from the health insurance fund's medical adviser. You need such an approval as soon as a treatment falls outside the common conditions, for instance for a condition on the Fa, Fb or E list.
That used to mean paper forms, posting them and waiting. With eAgreement, the request goes out from your software, you follow its status online and the approval comes back into your patient record. That way you know, before the course of treatment starts, how many sessions the fund will reimburse.
The difference at a glance
| eAttest | eFact | eAgreement | |
|---|---|---|---|
| What is it? | Electronic certificate of care provided | Electronic invoice under the third-party payment scheme | Electronic approval request to the medical adviser |
| Who pays you? | Your patient, the full amount | The health insurance fund, straight into your account | Nobody: it comes before certifying or invoicing |
| What does your patient pay? | Everything, and receives the refund in their own account | Only the patient co-payment and any supplement | Nothing extra |
| When do you use it? | When your patient pays you | When you apply the third-party payment scheme | For an Fa, Fb or E list condition |
| Mandatory from | 1 January 2027 | 1 January 2027 | 1 January 2027 |
When do you use which?
The three services do not exclude each other: they follow one another through your working day. For a treatment of a common condition, an eAttest or an eFact is enough, depending on who pays. If the treatment falls under a specific condition list, you first request an eAgreement and then certify or invoice as usual.
You choose between eAttest and eFact per patient. If your patient pays the full amount at the practice, an eAttest is all you need. If you apply the third-party payment scheme, you send an eFact. Many practices combine both, and that is perfectly fine.
What do you need to get started?
- Software that is connected to MyCareNet and supports all three: eAttest, eFact and eAgreement.
- A personal eHealth certificate. You request it free of charge with your electronic identity card, and good software walks you through the application.
- Fifteen minutes to enter your fees and bank details in your software, so your certificates and invoices are correct from the start.
What changes on 1 January 2027?
From 1 January 2027, eAttest, eFact, eAgreement and the electronic insurability check (Member Data) are required by law for every physiotherapist in Belgium. The paper certificate of care provided then disappears for good.
Waiting until December 2026 is not a plan. If you already certify and invoice electronically today, you will meet the deadline without stress and can get used to the new workflow at your own pace. If your current package cannot handle these services, see how to switch without hassle, or how an electronic patient record makes your admin lighter already today.
Want to know more about the full regulations? RIZIV-INAMI, the Belgian health insurance institute, gathers all official information on its page about MyCareNet for physiotherapists (in Dutch).
Sources
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Nollie puts eAttest, eFact, eAgreement and the insurability check to work out of the box. For €30 per therapist per month, all included.
See how Nollie handles eHealthFrequently asked questions
Is the eAttest mandatory for physiotherapists?
From 1 January 2027, the eAttest is required by law for every physiotherapist in Belgium, together with eFact, eAgreement and the electronic insurability check. Until then, you may still work with paper certificates.
What is the difference between an eAttest and an eFact?
With an eAttest, your patient pays you for the full treatment and the health insurance fund pays the refund to your patient. With an eFact, you invoice the fund directly and your patient only pays the co-payment.
Can every physiotherapist apply the third-party payment scheme?
Yes. Since 1 October 2015, every physiotherapist has been allowed to apply the third-party payment scheme to all patients, without prior formalities. It is a choice, not an obligation: you decide per patient whether to use eFact.
Do I need an eAgreement for every patient?
No. An eAgreement is only needed when the treatment requires approval from the medical adviser, for example for a condition on the Fa, Fb or E list. For common conditions, a prescription is enough.
Is the paper certificate of care provided going away?
Yes. From 1 January 2027, the eAttest fully replaces the paper certificate. Certificates are then sent electronically through MyCareNet to your patient's health insurance fund.
Read more
Requesting an eAgreement: from prescription to response
From a legible prescription to the health insurance fund's decision: how to prepare an eAgreement, follow up its status and provide missing information.
Checking insurability: how to read Member Data
What do the codes and messages in Member Data mean? Here is how to read your patient's insurability and what you still need to check before treatment and billing.
Requesting and renewing your eHealth certificate
Requesting a new eHealth certificate or renewing your existing one? Here is how to do it on Windows and Mac, from the card reader to the settings of your practice software.