Key Takeaways
- Online rezept claims send rezept data created in the rececon to the review and payment organization's online claims system over a secured network, and are the standard claim method under the claims ordinance.
- New use of optical disk claims ended in April 2024; institutions continuing them from October 2024 must file notice with a plan to move to online claims within one year.
- Online claims require a rececon, a claims terminal, an IP-VPN or IPsec+IKE line and an electronic certificate per terminal, and can share the line, terminal and certificate used for online eligibility verification.
- Institutions using online claims receive returned rezepts as return files (available for three months to download) and, in principle, reclaim them online.
"What exactly are online claims?" "What happens to our online claim setup when we replace the rececon?" "What line and certificate do we need?" These are common questions when preparing to open a clinic or reviewing claim methods. This article covers how online rezept claims work, how they differ from optical disk and paper, how they became the standard and how they are handled today, setup steps, the monthly flow and deadlines, receiving returns and point-adjustment notices, the relationship with online eligibility verification, and common troubles.
Disclaimer: This article provides general information based on publicly available sources as of October 31, 2026. Ministry ordinances and notices and the guidance of the review and payment organizations are authoritative on claim methods, notifications and reception hours. Always check the latest originals and the guidance of your review and payment organization.
The Social Insurance Medical Fee Payment Fund was reorganized in October 2026 as the "Japan Healthcare Payment & Digital Transformation Services" (DX review and payment organization). In this article we use the familiar name "payment fund."
What are online rezept claims?
Online rezept claims are a way of claiming by sending rezept data created in the rececon to the online claims system of the review and payment organization (the payment fund or the National Health Insurance federation) over a secured network. The method was added by an April 2006 amendment to the claims ordinance; it links institutions, review and payment organizations and insurers over a nationwide network to exchange claim data online.
Article 1 of the ordinance on claims for medical care benefits and publicly funded care (the "claims ordinance") makes claims using an electronic data processing system, that is, online claims, the standard method. Optical disk and paper claims are allowed only in cases set out in the ordinance's supplementary provisions.
For what a rezept is and the overall flow from submission to payment, see what is a rezept.
Online, optical disk and paper compared
The ministry's guide (as of March 2024) summarizes the differences as follows.
| Item | Online claims | Optical disk / paper |
|---|---|---|
| Submission | Data sent over a line | Disk or paper brought to the counter or mailed |
| Reception hours | Including weekends and holidays. 8:00-21:00 on the 5th-7th and 8:00-24:00 on the 8th-10th of the month after care | Not on weekends or holidays (accepted if the 10th falls on one). In principle until 17:30 on the 10th |
| Pre-check | Data can be checked in advance with the reception and clerical check ASP; flagged items can be fixed and resubmitted by the 12th | Rezepts with clerical errors are returned and reclaimed the following month or later |
| Post-review documents | Viewable in the online claims system and stored as data | Arrive on paper and are stored on paper |
With online claims, the system also checks that the claim goes to the right destination, and printing and mailing work disappears.
How online claims became the standard
The roadmap to bring online claims "close to 100%"
The Regulatory Reform Implementation Plan (Cabinet decision of June 7, 2022) called on the ministry to "create a concrete roadmap to bring the share of online claims close to 100% in the future." In response, a draft roadmap was presented to the Social Security Council's medical insurance committee on March 23, 2023. According to that document, in the payment fund's January 2023 processing, 153,845 institutions (70%) used online claims and 59,588 (27%) used optical disks.
The main points of the draft roadmap were:
- End new use of optical disk claims from April 2024, with existing users moving to online claims in principle by the end of September 2024
- Require institutions continuing optical disk claims to file notice with a migration plan, handled as a transitional arrangement renewed annually
- End new paper claims by institutions not using a rececon from April 2024
- End paper returns to online-claim institutions at the end of September 2024
Current rules (ordinance and notices)
This policy was put into effect by the 2023 amendment to the claims ordinance (Cabinet Office / MHLW Ordinance No. 8 of 2023) and its implementation notice (Hohatsu 1226 No. 4, December 26, 2023). The current handling is:
| Method | Current handling |
|---|---|
| Online claims | The standard method (Article 1). Institutions starting claims from April 2024 claim online |
| Optical disk | Allowed until September 30, 2024 only for institutions whose latest claim before March 31, 2024 was by optical disk. Continuing from October 2024 requires notice to the review and payment organization with a plan of no more than one year (Supplementary Provisions Art. 3-2) |
| Paper | Allowed only in cases set out in the supplementary provisions, such as filing notice that no rececon is used (Art. 3-4) or where all full-time physicians were born on or before certain dates (Art. 3-5) |
For continuing optical disk claims, a notice of May 28, 2025 (Hohatsu 0528 No. 1) stated that institutions continuing from October 2025 had to resubmit the notice and migration plan (Form 1) by August 31, 2025, that the plan covers at most one year with migration to online claims in principle within one year, and that continuing optical disk claims without a plan is not allowed. Submission is in principle through a form on the general portal site for medical institutions.
In addition, upon notice, optical disk or paper claims are allowed while a line failure persists, while rececon installation work is incomplete, while operating in a facility under renovation or a temporary facility, or where closure or suspension is planned (Supplementary Provisions Art. 4(5)).
What you need
| Item | Details | Sharing with online eligibility verification |
|---|---|---|
| Rececon | Creates rezept data. Also check that it supports importing return files and reclaiming online | — |
| Claims terminal | A PC that meets the online claims system's requirements | Can be shared |
| Network line | IP-VPN or IPsec+IKE connection | Can be shared |
| Electronic certificate | One per terminal | If the terminal is shared and the eligibility certificate is installed, no separate certificate is needed |
Lines: IP-VPN and IPsec+IKE
- IP-VPN: connects over a closed network built by the line provider. No internet service provider contract is needed
- IPsec+IKE: combines IPsec, which creates an encrypted path over the internet, with IKE, a standard key-exchange technology, to provide security equivalent to IP-VPN. Requires a contract with an IPsec+IKE service provider in addition to an internet service provider
Eligible lines and providers are listed in the payment fund's list of lines and providers that can connect to the online claims and online eligibility verification systems. There is no need to install a separate line for claims; the line used for online eligibility verification can be used.
Terminal and certificate
The claims terminal may be shared with the rececon at the user's own responsibility, but the ministry recommends preparing a separate one for security reasons. If an existing internet-connected terminal is used, anti-virus and other security measures are required.
The electronic certificate, issued by a certificate authority to prove the communicating party's identity, is required for the claims terminal. If claims use a different terminal from eligibility verification, a new certificate is issued (according to the ministry's material, 1,500 yen per certificate including tax, plus 753 yen postage per shipment). The software needed for the online claims system is distributed free of charge by the review and payment organization.
Setup steps
The ministry's guide describes four steps:
- Preparation: confirm online claim support with your rececon vendor, and contact line providers and terminal vendors
- Ordering: obtain quotes for terminals and lines (IP-VPN or IPsec+IKE providers) and place orders
- Applications to the review and payment organization: apply for online claims use and certificate issuance through the general portal site (no certificate application is needed if the terminal is shared and the eligibility certificate is installed). Newly opened institutions also submit a notice to the prefectural office of the payment fund's review committee
- Installation and preparation: configure using the setup tool and certificate issuance notice received, install the certificate, run a connectivity test, optionally run a confirmation test, and begin operation
The payment fund's Q&A states that applications are compiled monthly and setup tools are sent by the 15th of the following month, and that moving from electronic media to online claims takes about 1.5 to 2 months from application to installing the software and obtaining the certificate. Plan backward from your opening or switchover date.
Monthly flow and deadlines
| Timing | Work |
|---|---|
| Month end to around the 4th | Close the month; create and check rezepts in the rececon |
| 5th to 10th | Send to the online claims system. Check for clerical errors with the reception and clerical check ASP |
| 11th to 12th | Correct and confirm items flagged as errors (not accepted / needs confirmation) |
- Under Article 2 of the claims ordinance, each month's claims are made by the 10th of the following month
- Data not confirmed by the 10th is confirmed automatically except for error items. Error items must be corrected and confirmed on the 11th-12th or they fall outside the claim
- With online claims the claim form is also sent as data, so no paper claim form is needed
The ASP finds clerical errors such as missing entries. Matching diagnoses with services and checking billing requirements are done in your own pre-submission check (basics of rezept checking).
Receiving returns and notices online
Institutions using online claims also receive review documents and returned rezepts online.
- Documents: the payment fund distributes point-adjustment notices, return breakdowns, bank transfer notices, re-examination payment adjustment notices and others as PDFs through the online claims system around the 5th of each month. See reading point-adjustment notices and requesting re-examination
- Returned rezepts: since October 2024, paper returns to online-claim institutions have ended and returns come only as return files. Files can be downloaded for three months and are reclaimed online (returns sent only on paper are reclaimed on paper)
- Re-examination and withdrawal: requests such as withdrawal of claims from previous months are in principle submitted from the online claims system as re-examination request files
For handling returns see returned rezept reasons and reclaiming and returns vs. assessments; for withdrawal see withdrawing a rezept and error adjustment.
Relationship with online eligibility verification
Introducing online eligibility verification is in principle mandatory for covered medical institutions and pharmacies. Online eligibility verification and online claims can share the same network line and terminal, and if the terminal is shared, the certificate as well. Institutions that already use online eligibility verification may be able to start online claims without a new line or terminal.
Checking insurance eligibility at each visit through online eligibility verification also helps reduce returns caused by eligibility errors. See what mandatory online eligibility verification means.
Common troubles and whom to contact
Key points from the payment fund's Q&A:
| Situation | Response |
|---|---|
| Certificate not yet downloaded | It can be downloaded any number of times within 180 days of the issuance notice, but not after. Set it up soon after it arrives |
| Issuance notice lost | It cannot be reissued. Apply again for a certificate (paid) and revoke the lost one |
| Replacing the PC or certificate deleted | The old PC's certificate can be copied to media and used. If deleted, reinstall from backup or re-download within the period; otherwise apply again (paid) |
| Connection lost while sending | Data being sent is discarded, so resend after the line recovers. When receiving, resume from the point of interruption |
| Cannot reach the screen | Check the connection; if IPv6 is enabled on an IP-VPN (IPv4) connection, disable it. If unresolved, contact the network support desk |
| Line failure | Under the supplementary provisions, optical disk claims are allowed upon notice |
It also helps to know that contacts are split: the rececon vendor for creating claim data, the line provider (or IPsec+IKE provider) for the line, and the review and payment organization's help desk for operating the online claims system.
Summary
- Online rezept claims send rezept data over a dedicated network to the review and payment organization and are the standard method under the claims ordinance
- New use of optical disks ended in April 2024. Continuing from October 2024 requires a notice with a migration plan of up to one year
- You need a rececon, a claims terminal, an IP-VPN or IPsec+IKE line and a certificate per terminal, all of which can be shared with online eligibility verification
- Reception is from the 5th to the 10th of the month after care; ASP error items can be corrected until the 12th
- Point-adjustment notices and other documents arrive as PDFs around the 5th, and returns arrive as files (downloadable for three months)
For AI-assisted pre-submission checking see what is AI rezept checking, and for reducing the monthly workload see five ways to streamline rezept work.
Pottech provides AI electronic medical records and AI rezept checking that reflects billing requirements for clinics. If you need help building a checking process before online submission, please feel free to contact us.
Frequently Asked Questions
- Q. What are online rezept claims?
- A. They are a way of claiming by sending rezept data created in the rececon to the review and payment organization's online claims system over a secured network. The method was added by a 2006 amendment to the claims ordinance and is now the standard method.
- Q. Are online claims mandatory?
- A. Under the claims ordinance, online claims are the standard. New use of optical disk claims ended in April 2024, and continuing them from October 2024 requires a notice with a migration plan of up to one year. Paper claims are allowed only in cases set out in the ordinance's supplementary provisions, such as not using a rececon, upon notice.
- Q. What kind of line is needed?
- A. Either an IP-VPN connection over a closed network or an IPsec+IKE connection over the internet. IPsec+IKE requires a contract with an IPsec+IKE service provider in addition to an internet service provider. The line can be shared with online eligibility verification.
- Q. When can online claims be sent?
- A. From the 5th to the 10th of the month after care. According to the ministry's guide (as of March 2024), hours are 8:00-21:00 on the 5th-7th and 8:00-24:00 on the 8th-10th, including weekends and holidays. Items flagged by the pre-check can be corrected until the 12th.
- Q. Can the online eligibility verification terminal also be used for claims?
- A. Yes. The terminal and line can be shared, and if the eligibility verification certificate is already installed, no separate certificate is needed for claims.
参考・出典
- e-Gov法令検索「療養の給付及び公費負担医療に関する費用の請求に関する命令」（昭和51年厚生省令第36号）第1条〜第3条、附則第3条の2〜第4条 https://laws.e-gov.go.jp/law/351M50000100036
- 厚生労働省 保険局「オンライン請求開始に向けて必要な準備作業について」（令和6年3月時点版） https://www.mhlw.go.jp/content/12400000/001239087.pdf
- 厚生労働省「オンライン請求の割合を100％に近づけていくためのロードマップ（案）」（令和5年3月23日 第164回社会保障審議会医療保険部会 資料1） https://www.mhlw.go.jp/content/12401000/001076308.pdf
- 厚生労働省保険局長「『療養の給付及び公費負担医療に関する費用の請求に関する命令の一部改正に伴う実施上の留意事項について』の一部改正について」（令和7年5月28日 保発0528第1号） https://www.mhlw.go.jp/content/12400000/001717628.pdf
- 厚生労働省「返戻再請求のオンライン化についてのご案内」（令和6年7月時点版） https://www.mhlw.go.jp/content/12400000/001281172.pdf
- 医療情報基盤・診療報酬審査支払機構（旧 社会保険診療報酬支払基金）「オンライン請求システムに関するQ&A（概要）」 https://www.hpdx.or.jp/goshitsumon/online/online_01.html
- 医療情報基盤・診療報酬審査支払機構「オンライン請求システムに関するQ&A（ネットワーク）」 https://www.hpdx.or.jp/goshitsumon/online/online_07.html
- 医療情報基盤・診療報酬審査支払機構「オンライン請求システムに関するQ&A（電子証明書）」 https://www.hpdx.or.jp/goshitsumon/online/online_09.html
- 医療情報基盤・診療報酬審査支払機構「増減点連絡書・各種通知書の見方」 https://www.hpdx.or.jp/seikyushiharai/mikata/seikyushiharai_04.html
- 医療情報基盤・診療報酬審査支払機構「再審査請求（取下げ）の方法」 https://www.hpdx.or.jp/seikyushiharai/iryoukikan_saisinsa/index.html