U023 - Reimbursement Contestation
Articles 65(6), 65(7) of Regulation (EC) No 883/2004, Article 70 of Regulation (EC) No 987/2009
SED API version: 0.15.2 build 3
Model version: 4.1.0
1. Local case numbers
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1.1. Local Case Number
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1.1.1. Country
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1.1.2. Case number
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1.1.3. Institution
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1.1.3.1. Institution ID
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1.1.3.2. Institution Name
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2. General information
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2.1. Reimbursement request ID
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2.2. Reimbursement contestation ID
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3. Individual claims contested
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3.1. Individual claim contested
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3.1.1. Reimbursement request ID
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3.1.2. Reimbursement contestation ID
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3.1.3. Sequential number of Individual claim
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3.1.4. Contested individual claim ID
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3.1.5. Person
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3.1.5.1. Family name(s)
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3.1.5.2. Forename(s)
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3.1.5.3. Date of birth
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3.1.5.4. Sex
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3.1.6. Contestation type
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Non-acceptance of the individual claim
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Partial acceptance of the individual claim
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3.1.6.1.1. Reason for non-acceptance
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3.1.6.1.2. Please fill in the following if "Reason for non-acceptance" = "03 - Other reason or additional information" :
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3.1.6.1.2.1. Information about other reason or additional information
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3.1.6.2.1. Reason for partial non-acceptance
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3.1.6.2.2. Please fill in the following if "Reason for partial non-acceptance" = "01 - Partial acceptance due to ceiling under national law" :
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3.1.6.2.2.1. Amount intended to be reimbursed
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3.1.6.2.2.1.1. Amount
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3.1.6.2.2.1.2. Currency
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3.1.6.2.3. Please fill in the following if "Reason for partial non-acceptance" = "03 - Reimbursement claim incomplete" :
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3.1.6.2.3.1. Information on missing data
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3.1.6.2.4. Please fill in the following if "Reason for partial non-acceptance" = "99 - Other reason or additional information" :
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3.1.6.2.4.1. Additional information
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