What Does §302 SGB V Actually Regulate?
§302 SGB V obliges all approved providers of therapeutic services, medical aids and home nursing care to submit billing data electronically to statutory health insurers. Paper-based billing has not been accepted for many years. The law does not specify the technical format in detail; instead, this is governed by the Technical Annexes (TA) to Appendix 2 of the Framework Agreement under §125 SGB V, published by the umbrella associations of the statutory health insurers. For allied health practices, the relevant reference is the TA Heilmittel (TA HMV), which is updated regularly and was revised as part of the digital health strategy currently in effect in 2026.
The purpose of the legislation is straightforward: standardised, verifiable data sets that can be processed automatically by health insurers and that reduce the risk of billing fraud. In practice, this means that an incomplete or incorrectly structured submission will be rejected by the GKV clearing system before it even reaches the insurer.
- ✓Electronic submission is mandatory for all approved allied health providers
- ✓Technical specifications set out in the TA HMV (updated 2026)
- ✓Incomplete data sets are rejected at GKV clearing before reaching the insurer
- ✓Data set plus physical source document together constitute the complete claim
From Prescription to Payment: the Billing Process Step by Step
The §302 SGB V billing process begins the moment a prescription arrives at the practice. When a prescription is recorded – whether by card reader or manually – the insurer's IK number, patient master data and the prescribed therapeutic services must all be entered correctly. Errors at this stage propagate through the entire process.
Once the course of treatment is complete, the software compiles the billing data set: a structured file containing all services rendered, dates, position codes and amounts. In parallel, the source document – the signed prescription with treatment confirmation – must be retained. Data set and source document together constitute the complete claim; the insurer may request sight of the originals at any time.
The completed data set is transmitted via an approved platform – typically the GKV clearing system (ITSG/Bitmarck) – to the relevant health insurer. The insurer has up to ten weeks to review the submission. In practice, payment for error-free submissions typically arrives considerably sooner. Following review, a payment advice is issued to the bank account associated with the practice's IK number.
- ✓Step 1: Record prescription and verify patient insurance status and insurer IK
- ✓Step 2: Document treatment and record service data
- ✓Step 3: Secure signed source document and retain it
- ✓Step 4: Generate billing file and transmit via clearing
- ✓Step 5: Insurer review (up to 10 weeks)
- ✓Step 6: Payment to IK bank account plus payment advice
Position Codes: the Language of Allied Health Billing
Every therapeutic service billed to a statutory health insurer must be assigned a precise position code. These codes are maintained in the therapeutic services position code directories published by the insurer associations, covering everything from individual physiotherapy sessions to group treatments and home visit surcharges.
Position codes serve multiple functions: they identify the type of service, its duration and, in some cases, the qualification required of the treating therapist. An incorrect code – for example, billing manual therapy when only standard physiotherapy was prescribed and delivered – will trigger a rejection. Practice management software linked to current position code directories substantially reduces this risk.
Blank-prescription treatments (Blankoverordnung), which allow therapists to select specific interventions independently, introduce additional complexity: services must still be correctly coded, while documentation obligations are simultaneously more extensive. Practices offering blank-prescription care should verify that their billing software fully supports these scenarios.
- ✓Position codes are standardised nationally but maintained and updated by insurer associations
- ✓Incorrect codes result in automatic rejection at clearing
- ✓Blank prescriptions require additional care during coding
- ✓Regular updates to position code directories within the software are mandatory
Cost-Bearer Identifier and IK Number: Addresses within the System
Two identifiers are central to every §302 SGB V data set: the practice's own IK number (Institutionskennzeichen) and the cost-bearer identifier (KTR-Kennung) of the health insurer. Both must be entirely accurate – a single digit error results in the data set being attributed to the wrong recipient or rejected outright.
A practice's IK number is obtained from ARGE IK and remains permanently assigned. It uniquely identifies the practice within the GKV system and is linked to the bank account to which payments are credited. The insurer identifier can change when health insurers merge; practice management software must therefore keep these master data current at all times.
In practical terms, the software should automatically retrieve the cost-bearer identifier from the patient's insurance card chip or a maintained insurer database when a prescription is recorded. Practices not yet connected to the Telematikinfrastruktur (TI) must maintain this data manually – a potential error source that will largely disappear as TI connection becomes mandatory for allied health providers on an incremental basis.
- ✓Practice IK number: obtained once from ARGE IK, permanently valid
- ✓Insurer cost-bearer identifier: must be kept current in the software
- ✓TI connection automates master data reconciliation
- ✓Payments are always credited to the bank account linked to the practice IK
Electronic Data Submission: What Is Actually Transmitted
The term DTA – Datenträgeraustausch, literally 'data medium exchange' – dates from the era of floppy disk submissions. Today it refers exclusively to electronic transmission of billing data in a standardised file format (currently TA HMV-compliant, XML-based). The clearing system (e.g. ITSG) performs a formal check before forwarding the data to the insurer.
A complete §302 data set contains: the billing period and submission date; the practice IK number; the insurer cost-bearer identifier; one line per service rendered with position code, quantity, unit amount and date of service; the patient's insurer number and name; and prescription details including issue date, prescribing physician's IK and ICD-10 diagnosis code.
The rollout of the electronic prescription (eVO) for therapeutic services means that prescription data will increasingly flow directly from the TI into the billing system, eliminating manual entry and reducing errors. As of 2026, the eVO rollout for allied health services is underway in pilot regions.
- ✓File format: TA HMV-compliant (XML-based), transmitted via ITSG/Bitmarck clearing
- ✓Data set includes: IK, cost-bearer identifier, service lines, patient insurer number, ICD-10
- ✓eVO (electronic prescription) progressively reduces manual data entry from 2026
- ✓Malformed data sets are rejected by clearing before reaching the insurer
Source Documents: Retention, Audit Rights and GoBD
The electronic data set alone is not sufficient in law. Allied health providers must also retain source documents – signed original prescriptions together with treatment confirmation showing that services were rendered. Health insurers have the right to request these documents during efficiency audits or spot checks.
The retention period for source documents under social security law is generally ten years – mirroring the tax law retention period under the GoBD. Practices managing records digitally must ensure that digitised source documents are stored in an unalterable form in line with audit-proof archiving requirements. Simply saving files in a desktop folder does not meet the legal standard.
GoBD-compliant software enables legally sound digital archiving with an unbroken, documented link between the data set and the source document – making it considerably easier to respond to audit requests.
- ✓Retention obligation: 10 years under SGB V and GoBD
- ✓Health insurers may request source documents at any time
- ✓Digitised source documents must be stored in an unalterable, audit-proof format
- ✓GoBD-compliant archiving links data set and source document traceably
Self-Billing vs. Billing Centre: Which Makes Sense?
The choice between self-billing and outsourcing to a billing centre is one of the most strategically significant decisions a therapeutic practice faces. Billing centres typically charge between two and five per cent of billing volume as their fee. On a monthly GKV turnover of 30,000 euros, that amounts to up to 1,500 euros per month – or up to 18,000 euros per year that does not remain in the practice.
The appeal of a billing centre lies primarily in the reduction of workload: the centre handles file generation, transmission and rejection management. This sounds attractive – but only until the practice has software that automates data set creation. Modern practice management software that is §302-compliant generates the finished data set at the click of a button. What remains is transmission and checking the payment advice – a matter of minutes.
Self-billing puts the practice fully in control: of the submission date (and therefore cash flow), of error correction and of archiving. The saving on centre fees frequently covers the annual subscription cost of a full-featured practice management system several times over. A switch to self-billing should be properly prepared: working through the process with real software in a test phase substantially reduces the initial risk.
- ✓Billing centres: 2-5% fee on billing volume
- ✓Self-billing: full cost control and better cash flow management
- ✓Modern §302-compliant software automates data set creation
- ✓One-off learning investment when switching – no ongoing centre fees thereafter
- ✓A test phase with real software is strongly recommended before the full switch
TheraNext and §302: What the Software Takes Care Of
Practice management software such as TheraNext covers the entire §302 process end-to-end: from prescription recording through automatic position code assignment to the finished, TA HMV-compliant data set. Potential issues such as an outdated insurer identifier or missing mandatory fields are flagged before transmission – not after submission.
Because TheraNext operates entirely in the browser and is GoBD-compliant, audit-proof archiving of source documents is available directly within the system. The link between prescription, services rendered and transmitted data set is documented without gaps, making it straightforward to compile a complete audit package when required.
Practices considering the move to self-billing under §302 can try TheraNext free of charge – with no commitment and no set-up fee. The transition from a billing centre typically takes a few weeks with the support of the onboarding team.
Written & reviewed by
TheraNext Editorial Team
Billing and Practice Management Specialist