FAQ - RA/PID
RA/PID - GENERAL QUESTIONS
In institutions with several doctors using the establishment's UCM code for MH, do we need one certificate per health professional? How does the professional's UCM code differ from the institution's?
If the code in the "Provider code" field in the "Billing" zone of the XML refers to the hospital's UCM code, the compensation will be allocated to the hospital (or association of doctors). It is then up to the association to make arrangements within its members according to the internal rules for allocating the indemnity per document (according to overhead allocation keys that may or may not exist within these doctors' associations, or any other internal method).
If each doctor wants to receive his own allowance, then his "personal" provider code shall be used on the MH and in the XML.
Once the specifications have been analyzed and the first developments made, you can request access to the test environment. For that :
1. Request a test provider code from the CNS using the procedure in the document "CNS_Procedure for requesting a test provider code_00.01.pdf".
2. Use the procedure described in the video to activate your test space in MySecu, specifying the test provider code.
3. Email the Agence eSanté Helpdesk with the provider code allocated by the CNS.
When all your tests are conclusive, contact the Agence eSanté using the online form to enter the certification stage.
The provider code corresponds to the CNS invoice code, which starts with 9 and is usually used by doctors on their prescriptions, for example.
The MH identifier is used to confirm that the CNS has received the MH correctly. It is the one indicated in the electronic exchanges.
In the context of setting up the RA/PID, mention is made of the eHealthID. Could you tell us the procedure for obtaining this ID, which is needed to set up the secure connection?
The eHealthID is the doctor's eSanté identifier. If the doctor doesn't know it, he or she can find it in the DSP by selecting his or her name in the top right-hand corner, or by contacting our Helpdesk.
No, the delivery note must be completed on headed paper signed by the doctor confirming delivery of your solution. The version of software delivered must be clearly specified too.
The delivery note must also state « Si le M/MD est techniquement en capacité de travailler avec plusieurs solutions logicielles sur un même lieu de travail, l’industriel doit avertir le M/MD de s'engager à ne livrer que les pièces nécessaires pour justifier son raccordement à la solution qu’il entend utiliser de manière largement prépondérante en production pour le transfert des MHs » (§220.127.116.11 of the Reference Specification File).
No, there is no template available. Your customer must sign a document on headed paper to confirm that he has received the training service described on p.19 §18.104.22.168 of the Reference Specification File.
You can also refer to §22.214.171.124.6 of this same document for further information.
If the training involves several M/MD within a medical practice, the training certificate must be signed by the private individual doctor trained in accordance with §126.96.36.199 of the Reference Specification File.
No, Healthnet is not required for PID implementation.
After analyzing the documentation, the SOAP file expected during first authentication cannot be identified. Could you give us an example or the location of the security header and the Body in the Java demo code?
There isn't a complete example, because all you have to do is add the Body to a SOAP message with the requested Header. If you need more information on the SOAP format, you can consult reference sites such as https://www.w3schools.com/xml/xml_soap.asp
In the demo zip, you can also consult the sampleSaop11.xml file, or the lu.ciss.mysecu.demo.wst.AuthenticationRequest file, which shows, among other things, how the various elements are added to the Envelope.
Management of patient consent for transmission of the MH: does the patient have to give his or her consent for the MH to be sent to the CNS?
Consent management depends on the architecture of your solution. First of all, the patient must give their consent, which authorizes the doctor to send a digital document to your MySecu space. This consent shall be managed by you, along with your collection and storage procedures. The digital document is stored in a buffer zone managed by the Centre Commun de la Sécurité Sociale.
Then, depending on the method used by the patient to give their consent to the CNS to process their document (mobile app, web portal), they must accept the general conditions of use of the tool they are going to use (CNS app, MyGuichet app or other).
Finally, using a function in the chosen tool, the patient give their consent for the document to be taken out of the buffer zone and injected into the CNS processing systems for reimbursement.
Management of Patient Consent for PID Agreement: does the patient have to agree to the PID? If yes, how?
As with RA, managing the consent that authorizes the doctor to use the PID system depends on your solution and is your responsibility.
The patient's agreement to the results of the simulation and, in particular, to the amount to be paid by him is given orally to the doctor (secretariat if responsibility is delegated). By validating the simulation, the doctor (secretary if responsibility has been delegated) confirms that he/she has requested and received the patient's verbal agreement.
The specifications do not mention a signature required for transmission of the MH, although there is a section in the XSD of the transmission webservice1, but without explanation.
As indicated in the technical documents submitted as part of the financial incentive procedure for RA/PID services, these documents are evolving. At present, they do not include the specifications relating to electronic signatures. When the time comes, a new version of these documents will be issued with details of the documents requiring a signature and the type of signature to be used.
How should RA be triggered when the patient does not pay directly but by bank transfer? Should there be a special status for these MH before launching RA in order to validate the payment?
If the payment is not immediately performed, the doctor must set the "not paid" boolean to 0 in the XML and the "Q" tag to 0 in the Datamatrix. Then he sends the XML / PDF to the CNS and gives a paper version with Datamatrix to the insured.
Once the patient made the bank transfer to the doctor, he sends the Memoire d’Honoraires and proof of payment to the CNS. The CNS scans and checks the proof of payment and searches for the XML based on the Datamatrix.
Unpaid documents cannot be accessed by patient via their App (the "Send to CNS" function is deactivated).
In short, if the MH has not been paid, the paper circuit is automatically used.
Has an official date been set for the launch of the PID, as dental practices are asking to business software publishers ?
From September 2023, general practitioners will be the first to be able to use the PID.
Subsequently, other medical specialties (dentists, dermatologists, pneumologists, etc.) will be added to the nomenclature of acts and services for doctors and dentists. We will keep you informed of developments as they occur.
In the first phase of the PID, the handling of files requiring attachments, manual interventions and prior agreements are excluded.
Below is a list of the challenge codes and the corresponding descriptions provided, as of today, by the CNS:
1 Dispute - Interpretation of a pricing rule by the rules engine
2 Dispute - Finding of a programming error in the rules engine
3 Dispute – Other
For information, this list is based on Article 25 paragraph 3 of the Agreement between the National Health Fund and the Association of Doctors and Dentists, concluded in implementation of Article 61 et seq. of the Social Insurance Code.
Agreement for doctors (Coordinated text applicable from 01.09.2021)
Please find attached a CNS link explaining the current limitations and exclusions of the PID: https://view.genial.ly/651d05d56b3bf30011e184bf
In order for the doctor to be entitled to compensation* under the PID, the entire PID process must be successfully completed, i.e. a simulation submitted by the doctor to the CNS rules engine and resulting in the CNS paying for the PID.
*in accordance with Article 110 of the Agreement between CNS and the AMMD, for doctors ; and in accordance with Article 111 of the Agreement between CNS and the AMMD, for dentists.
In the case of the PID, a doctor indicates that two 1N51 code acts can be sent on the same MH, but in this case the time of each act must be specified. After testing, the system indicates that no act is supported. What should we do?
Billing several 1N51 code acts on the same day is a little bit different in PID compared with conventional billing via a “Remboursement Accéléré” or paper fee statement.
In order for the rules system to automatically process several sessions on the same day for the same patient, the doctor must enter the session number for each line containing the 1N51 code act ("numeroSeance" data) in the simulation. This simulation must therefore be run at the end of the last session of the day for the same patient.
In fact, the rules system doesn’t take into account the time the act was performed, only the day, which is why CNS has introduced the notion of session number specific to the PID.
If this operating mode does not suit the doctor concerned, the professional always has the option of contesting the result of the simulation. The challenge will then be examined by the committee ad hoc.
A doctor is unable to use the PID service for technical procedures such as MAPA (Holter blood pressure monitoring), Holter cardiac monitoring, ultrasound and spirometry. Is this normal?
The following procedures work with the PID:
- 1C14 Holter
- 1C38 Continuous recording of blood pressure
- 1P73 Determination of residual volume and bronchial resistance
- 8E01 Ultrasound
However, when invoicing the rental of equipment for these procedures, the letter "X" is an integral part of the procedure code and should not be communicated as a supplement to the procedure.
Please find the link to the online form to be completed :