The third-party payment system relieves the patient from having to advance all or part of the costs during a consultation or medical procedure. For healthcare professionals, this mechanism involves two distinct reimbursement flows, one from the mandatory health insurance (AMO) and the other from supplementary health insurance (AMC), each with its own billing, payment, and rejection rules.
AMO flow and AMC flow: two payment circuits with different logics
The most common confusion among professionals starting with third-party payment is treating the mandatory and supplementary parts as a single block. The two circuits operate under distinct rules.
On the AMO side, billing is done through the electronic care sheet (FSE) transmitted via the patient’s Vitale card. Mandatory schemes have harmonized their procedures: once an FSE is sent, payment is guaranteed based on the rights recorded in the Vitale card, even if it is not up to date. Rejections related to discrepancies between the rights on the card and those in the health insurance databases have been eliminated.
On the AMC side, the situation is more heterogeneous. Rejections can arise from closed supplementary rights, inconsistencies between the patient’s contract and the transmitted data, or a procedure not covered by the relevant mutual insurance. The supplementary part concentrates the majority of the operational risk of third-party payment for practitioners. This is where most unpaid bills and time-consuming follow-ups occur.
To delve deeper into the mechanisms specific to each flow and the associated tools, the tp santé service on Passez l’info details the steps for configuration and monitoring tailored to each situation.
NOEMIE Returns: an underutilized management tool by practices
NOEMIE returns (Open Standard for Exchange between Health Insurance and External Stakeholders) are often perceived as mere payment acknowledgments. Their actual function goes beyond that.
Each NOEMIE return identifies the paying organization, the code, and the specific reason for the rejection. This granularity allows for correcting the invoice and resending it quickly, provided a structured follow-up is in place. Practices that do not utilize these returns accumulate untreated rejections, which deteriorates their cash flow over several weeks.
The systematic reconciliation of issued invoices and received returns forms the foundation of reliable third-party payment management. This task becomes particularly dense when the practitioner simultaneously applies third-party payment to both AMO and AMC parts, as each flow generates its own returns with different timelines and formats.
- Check NOEMIE returns daily in the billing software to spot rejections as they arise
- Classify rejections by reason (closed rights, contract inconsistency, non-covered procedure) to identify recurring causes
- Resend corrected invoices promptly to avoid accumulating outstanding receivables
- Keep a record of exchanges with supplementary organizations in case of prolonged disputes
Outsourcing third-party payment management: what providers actually handle
Faced with administrative burdens, an increasing number of healthcare professionals delegate all or part of third-party payment management to specialized providers. The scope of intervention varies according to the offers, and expectations do not always match the reality of the service provided.
Providers generally handle the verification of files before teletransmission, the analysis of anomalies in returns, and follow-ups with paying organizations. Outsourcing does not eliminate rejections; it organizes their processing. The practitioner remains responsible for the quality of the information entered at the time of billing, particularly the data from the Vitale card and the identification of the supplementary insurance.
A rarely discussed point: the cost of outsourcing is mainly justified for practices with a high volume of procedures or for multidisciplinary structures where the diversity of procedures multiplies the cases of rejection. For a solo practitioner with a stable patient base, the cost-benefit ratio should be evaluated on a case-by-case basis.
Generalization of third-party payment: regulatory calendar and current limits
The generalization of third-party payment for the health insurance part has been announced and postponed several times since the Health Law of 2014. In practice, the generalization to the AMO part will only take effect on October 1, 2026. Until that date, third-party payment remains mandatory in certain specific situations and optional in others.
The cases where third-party payment applies by law include beneficiaries of complementary health insurance solidarity, patients with long-term illnesses for care related to their condition, and procedures covered by the 100% Health scheme. Outside of these situations, the healthcare professional can offer it without being obliged to do so.
- Complementary health insurance solidarity (formerly CMU-C and ACS): full mandatory third-party payment
- Long-term illness (ALD): third-party payment on the AMO part for related care
- 100% Health (optical, dental, audiology): full third-party payment on baskets with no out-of-pocket costs
The “My Psychological Support” reform, which came into effect on June 15, 2024, has also expanded direct access to psychologists with a package of annual sessions covered, but third-party payment for this scheme remains limited to certain configurations. The billing process for contracted psychologists remains uneven depending on the funds and software used.
Third-party payment improves access to care for patients but transfers a significant management burden to practitioners. The supplementary part, with its variable processing rules from one organization to another, generates the majority of rejections and follow-ups. Utilizing NOEMIE returns in real-time and correcting invoices without delay remains the most direct method to limit unpaid bills.
