TARDOC concerns doctors, XML 5.0 concerns therapy

TARDOC in outpatient medicine and differentiation from therapy

TARDOC is the new individual benefit tariff structure for outpatient medical services. The Federal Council has approved TARDOC together with outpatient lump sums for the start on January 1, 2026. This replaces the TARMED doctors' tariff plan, but not billing in therapy practices. The existing contractual principles remain in place for physiotherapy, occupational therapy, complementary medicine, podiatry and other non-medical service providers. Anyone running a therapy practice does not have to introduce TARDOC and can fully concentrate on the XML 5.0 billing standard.

XML 5.0 in detail for billing in therapy practices

XML 5.0, called GeneralInvoice 5.0, is the new standard for electronic invoices and recovery documents in Swiss healthcare. It has been valid since January 2025 and will be used productively from 2026; older formats such as 4.5 will continue for an orderly migration period. For practices, this means that they should adapt their master data, document output and interfaces to the new structure in good time.

Separate GLN and ZSR cleanly

A central point is the identification of those involved with GLN. What was previously partly maintained with EAN is consistently managed as GLN in 5.0. The GLN is used to uniquely identify practice locations and service providers in all news. In addition, the ZSR remains as a contractual approval number, but is technically decoupled from the GLN. This allows clean illustrations when there are multiple affiliations and when working in different locations.

Everyday example: A physiotherapist works at two locations in the same region. Each location has its own GLN, and the therapist also has a personal ZSR for billing with insurance companies. In XML 5.0, it is clearly stated for each invoice at which location the service was provided, while the CSR remains unchanged assigned to the therapist. In this way, location transparency and contractual allocation are correctly fulfilled at the same time.

Expanded partner and patient data

The partner structure is new, expanded and standardized. Roles such as prescriber, employer, main practitioner or other parties involved are managed as partners with clear types. As a result, additional care actors can be included in a standardized manner, even though they do not have a GLN. This is particularly useful for therapeutic practices when prescriptions come from medical practices or clinics or when interprofessional treatments need to be documented.

Patient data is recorded more precisely. XML 5.0 distinguishes between social sex (gender) and biological sex (sex) and makes the AHV number mandatory so that clear assignments in insurance systems are possible. Cards and insurance features are consistently transferred to the fields provided for this purpose. At the same time, address data is more normalized, street name and house number are kept separately, which significantly improves validations and comparisons.

Modernized document flows and transport routes

When it comes to document flows, XML 5.0 modernizes payment processes. Invoices and recovery documents contain structured QR information. For the paper channel, there are standardized print templates with so-called Structured Append QR codes, with which a complete XML invoice can be reconstructed electronically from a printed document. At the same time, it is ensured that insurers may receive an electronic XML file, while insured persons retain the right to a comprehensible copy of the invoice on paper.

Message transport is also becoming more flexible. The use of an intermediary is no longer mandatory; communication can take place directly between service provider and insurer or continue via intermediaries, depending on the process and contract. The requirements for container signature and encryption are described in the associated 5.0 specifications and form the basis for secure and traceable data exchange. In practice, this means less dependence on individual transport routes and clearer responsibilities for receipts and error handling.

At the level of benefit items, 5.0 clarifies various fields. Group sizes can be specified correctly, field lengths for codes have been extended where medically or collectively necessary, and additional services can be recorded in a structured manner. The system is technically prepared to represent references to outpatient packages from the hospital world without this having a tariff effect on therapeutic practices. For the day-to-day life of a practice, it is crucial that the software correctly represents these structures and properly supports the rules for tier guarantor and tier payant. In Tiers Garant, the patient receives the bill and submits it to the insurance fund; in Tiers Payant, the bill goes directly to the insurer. Depending on the insurer, service and contract, both models remain valid. Tiers payant is generally considered inpatient, while animal guarantor traditionally prevails on an outpatient basis, unless otherwise agreed.

What does that mean for practical introduction?

It is already worthwhile to check GLN for practitioners and practitioners, to maintain ZSR separately, to systematically record AHV numbers and to correct address data.

XatlaMed fully implements XML 5.0 for customers. This includes the consistent use of GLN in all roles, the clear separation from the CSR, extended patient data with an AHV number requirement, QR-compliant recovery documents and invoices, as well as the updated transport and safety requirements. For practices, this means that no manual field migration is necessary and that receipts and files comply with insurers' audit routines. We support the implementation with master data checks, test scenarios and productive changes so that billing continues seamlessly in the new year.

conclusion

TARDOC is not an issue for therapeutic practices, as it affects the medical tariff world and will replace TARMED from 2026. The relevant change is XML 5.0, which is valid from 2025 and will be used productively from 2026. The standard provides unique identification via GLN while continuing to use the CSR, more precise patient data with AHV number, standardized QR documents and more flexible transport routes. Anyone who now carefully aligns master data and processes and tests the new documents is ready at the turn of the year and benefits from stable, verifiable statements. With the full implementation in XatlaMed, technical details, validations and print samples are approved so that teams can focus on treatment.