Create an Invoice for Sistema Tessera Sanitaria
If you are a healthcare provider (doctor, dentist, psychologist, physiotherapist, etc.) in Italy, you must transmit your patients’ healthcare expenses to the Sistema Tessera Sanitaria for tax return pre-filling (730). This guide explains how to create an invoice for Sistema TS (non-electronic) with FatturaSmart.
Important: Sistema TS invoices are different from electronic invoices sent to SDI. Sistema TS only receives healthcare expense data, not the complete XML document.
Before you begin
To send invoices to Sistema Tessera Sanitaria you need:
- A FatturaSmart account with active Sistema TS license
- STS credentials configured (how to configure them)
- Patient data (tax code is mandatory)
Part 1: Create the Invoice
Step 1: Start a New Invoice
- From the sidebar menu, click on Invoices
- Click the New invoice button (or press the + key)
Step 2: Select the Client (Patient)
- Click the Client button at the top
- Search for an existing client or create a new one
- Enter patient data:
- Tax Code (mandatory for Sistema TS)
- Full Name and Surname
- Complete Address
Recipient Code: For Sistema TS invoices to private individuals, use the recipient code “0000000” (seven zeros). FatturaSmart sets this automatically when you enable Sistema TS submission.
Step 3: Add Service Lines
- Click the + button to add a line
- Fill in the fields:
| Field | Description |
|---|---|
| Description | The healthcare service provided |
| Quantity | Number of services |
| Unit price | Service amount |
| VAT | Select the correct rate (often exempt for healthcare services) |
Step 4: Set Up Payment
- Go to the Payment section
- Select the Payment method (e.g., Cash, Bank transfer, Card)
- Set the Due date
Tracked payment: For the patient’s tax deductions, it’s important to indicate whether the payment is traceable (bank transfer, card, POS) or not (cash).
Part 2: Enable Sistema TS Submission
Step 1: Open Sistema TS Settings
- On the invoice screen, click on Other Data (three-dot icon or additional menu)
- Click on Send to Health Card System
A side panel will open with specific options for Sistema TS.
Step 2: Fill in Required Data
| Field | Description | Notes |
|---|---|---|
| Expense Type | The healthcare service category | Required - see table below |
| Expense Type Flag | Additional information (only for some types) | Optional |
| Tracked Payment | Whether payment is traceable | Affects patient’s deductions |
| Data Sharing Opposition | If the patient opposes data sharing | Document is sent anonymously |
Available Expense Types
| Code | Description | When to use |
|---|---|---|
| SP | Healthcare Services | Medical visits, consultations, therapies |
| SR | Specialist Care Expenses | Specialist visits, diagnostic exams |
| TK | Ticket | Emergency room ticket, copay |
| AS | Health Expenses | ECG, spirometry, instrumental exams |
| FC | Pharmacy | Medicines and drugs |
| AD | Medical Device Purchase/Rental | Medical equipment, temporary prostheses |
| PI | Prosthetics and Integrative | Dental prostheses, glasses, hearing aids |
| CT | Thermal Spa Treatments | Prescribed thermal treatments |
| IC | Cosmetic Surgery/Medicine | Aesthetic procedures |
| AA | Other Expenses | Expenses not classifiable elsewhere |
| SV | Veterinary Expenses | Veterinarians only |
| FV | Veterinary Pharmacy | Veterinarians only |
Expense Type Flag
The flag is only available for certain expense types:
| Flag | Description | Compatible Expense Type |
|---|---|---|
| 1 | Emergency room ticket | Only for TK |
| 2 | Intramoenia visit | Only for SR |
Step 3: Confirm the Data
- Verify all fields are filled correctly
- Click Save to confirm Sistema TS settings
You’ll see an icon or indicator confirming the invoice is configured for Sistema TS submission.
Part 3: Save and Send the Invoice
Save as Draft
If you’re not ready to send yet:
- Click Save
- The invoice is saved with status “Draft document for Health Card System”
- You can edit and send it later
Send to Sistema TS
When you’re ready to send:
- Click Send to TS System (button in the summary section)
- The document is queued for automatic submission
Confirmation message: After sending you’ll see the message “Document being processed. You’ll receive a notification when it’s sent to Sistema TS.”
Sistema TS Document Statuses
| Status | Meaning |
|---|---|
| Draft document for Sistema TS | Invoice saved, not yet sent |
| Awaiting send to Sistema TS | Invoice queued for sending |
| Sent to Sistema TS | Invoice transmitted to Sistema TS |
| Delivered to Sistema TS | Invoice received and registered |
Part 4: Check the Protocol Number
After sending, Sistema Tessera Sanitaria assigns a protocol number that certifies data receipt.
Where to Find the Protocol
- Go to the Invoices list
- Click on the sent invoice to open the detail view
- In the left column you’ll see a “Sistema TS Protocol” section
- The protocol number is shown in monospace format
When does the protocol appear? The protocol is assigned by Sistema TS after processing. It may take a few minutes. Refresh the page to see the updated protocol.
Verify on the Sistema TS Portal
For official verification, you can check directly on the Sistema TS portal:
- Access sistemats1.sanita.finanze.it
- Go to the “Receipt Consultation” or “Submission History” section
- Search by date or protocol number
- Verify the submission status
Mandatory verification: It is your responsibility to verify that the data transmitted by FatturaSmart to Sistema TS is correct. Regularly access the Sistema TS portal with your credentials to check that all documents have been received and registered correctly.
Patient Opposition to Data Sharing
The patient can oppose the sharing of their healthcare data for 730 pre-filling.
How to Handle Opposition
- In the Sistema TS panel, enable the “Client opposes data sharing” option
- Patient data will be transmitted anonymously
- The invoice shows a lock icon indicating opposition
What is Transmitted in Case of Opposition
- The expense amount
- The type of service
- The date
- The patient’s tax code is NOT transmitted
Cancel a Sistema TS Submission
If you sent an invoice by mistake, you can cancel the submission:
- Go to the invoice detail
- Click Cancel send to STS System
- Confirm the operation
Note: Cancellation is only possible for documents not yet processed by Sistema TS. If the document has already been registered, you’ll need to proceed with a correction through the Sistema TS portal.
Frequently Asked Questions
Can I send the same invoice to both SDI and Sistema TS?
No, they are separate flows. Sistema TS invoices are non-electronic documents intended exclusively for healthcare expense reporting. If you need to issue an electronic invoice to a company (e.g., insurance), that goes to SDI.
What happens if I select the wrong expense type?
You’ll need to cancel the submission (if possible) or make a correction through the Sistema TS portal. It’s important to select the correct expense type before sending.
Can the patient see their data on the pre-filled 730?
Yes, data transmitted to Sistema TS is used by the Italian Revenue Agency to pre-fill the patient’s 730 tax return. Patients can see healthcare expenses in their pre-filled declaration.
When must I submit the data?
Data must be transmitted within the deadlines established by the Revenue Agency. Deadlines may vary from year to year, so always verify official deadlines on the Revenue Agency or Sistema TS website.
Do I need to print the invoice for the patient?
Yes, the patient must receive a copy of the invoice (paper or PDF). Transmission to Sistema TS only concerns data for pre-filling and doesn’t replace providing the document to the patient.
How do I verify if the submission was successful?
- Check the document status on FatturaSmart
- Verify the protocol number appears in the dedicated section
- For absolute certainty, check on the Sistema TS portal
Common Problems
”Invalid STS credentials”
Sistema TS credentials may be expired or incorrect. Verify the configuration.
Important: Whenever you change your Sistema TS credentials (for any reason: expiration, password reset, user change, etc.), you must update them immediately on FatturaSmart as well. If the credentials are not updated, we will not be able to send documents to Sistema TS on your behalf.
”Submission error”
- Verify the patient’s tax code is correct
- Check that the expense type is filled in
- Make sure the invoice date is valid
Protocol number doesn’t appear
- Wait a few minutes after sending
- Refresh the invoice detail page
- Verify on the Sistema TS portal if the submission was received
Next Steps
- Configure Sistema TS default values - Save time with preset values
- Manage Payments - Track invoice payments
Need help?
If you have questions about Sistema TS submission, contact us:
- WhatsApp: +39 351 410 2536
- Email: support@fatturasmart.com
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