Posted on Tuesday, June 30, 2015
One of your patients, beneficiary of a military invalidity pension, requests the payment of an act or a care service, under article L.115 of the military pensions code of disability and war victims (CPMIVG).
To justify his rights under this legislation and allow you to judge the care relationship, your patient must present to you:
- his certificate giving entitlement to free medical care issued by the DSMG of the CNMSS,
- its description of the infirmities (FDI),
- if applicable, the medical prescription (medical auxiliaries, pharmacists, equipment suppliers) and / or the agreement to pay for the CNMSS mentioning the amount of reimbursable expenses under article L.115,
- possibly, his Vitale card (the one issued by your health insurance plan).
However, if you have to use his Vitale card to send your billing to the Free Medical Care Department of the CNMSS (case 835), it is imperative that you have the software version SESAM-Vitale in accordance with CoC 1.40 – addendum 6.
Failing that, your teletransmitted billing will reach the health insurance organization to which the pensioner is responsible (if it is the CNMSS, at the identification and services department – cash 756) and the flat-rate contributions and medical deductibles will be withheld from each act or service.
If in doubt about the compatibility of your professional software with the version required to upload your invoices to DSMG, do not hesitate to inquire at the CNMSS, by calling 04 94 16 97 01.
The request for prior agreement is mandatory in the following cases:
- When it is provided for in the nomenclatures of social security: acts and services of doctors (CCAM, NGAP), laboratories (NABM) and list of reimbursable products and services (LPPR).
- To perform dental prosthetic care.
- When the takeover goes beyond the social security responsibility tariff (TRSS).
- If it is about drugs or supplies not covered by social security, but which may, under certain conditions, be reimbursed under the SMG.
Regarding acts or services not related to disabled pensioners, these are covered by the social security body, to which the pensioner reports, as part of health insurance.