Build Electronic Care Sheet (FSE — Norme B2 / SESAM-Vitale)

Skill: Convert a care act into an electronic care sheet billed to health insurance

Region: France Category: Health care — Assurance Maladie (CNAM) Does: Takes a healthcare act (consultation, procedure, dispensing) and maps it onto a Feuille de Soins Électronique (FSE) in the Norme B2 (inter-régime) format, teletransmitted through SESAM-Vitale to the Assurance Maladie, with supporting documents via SCOR. Spec: CNAM Norme B2 inter-régime exchange format + SESAM-Vitale secured teletransmission (+ SCOR for scanned pièces justificatives)

The FSE carries one care episode billed to the patient's health-insurance scheme; the payer's response and payment detail come back via NOEMIE (see parse-noemie-retour). B2 is the long-standing inter-régime billing standard underlying SESAM-Vitale teletransmission.

When this applies

• A health professional (PS) bills an act covered by Assurance Maladie, reading the patient's Carte Vitale and the PS Carte CPS to secure the FSE.
• Used in tiers payant (third-party payment) and out-of-pocket flows; the B2 file groups one or more FSE/lots for télétransmission.

Structure (B2 → records)

Lot/Header  emetteur (PS) identifiers, organisme destinataire, dates, numéro de lot
FSE (per care sheet):
   Assuré/Bénéficiaire   NIR (numéro de sécurité sociale) + rang, date de naissance
                         caisse de rattachement (grand régime + caisse + centre)
   PS exécutant/prescripteur   numéro AM / RPPS / FINESS, spécialité, conventionnement
   Actes (lignes):  date, code acte (CCAM / NGAP), quantité, coefficient,
                    montant (base de remboursement), dépassement
   Taux & parts:   taux de remboursement, part AMO (obligatoire), part AMC (complémentaire),
                   ticket modérateur, participation forfaitaire / franchises
   Mode:  tiers payant (AMO/AMC) ou non, ALD/maternité exonération

Mapping & rules

• Patient identification — the NIR + rang de naissance and caisse de rattachement must come from the Carte Vitale; mismatches cause NOEMIE rejections.
• Act coding — use CCAM for technical/procedural acts and NGAP for clinical acts; apply the official base de remboursement and any coefficient.
• Reimbursement split — compute part AMO at the applicable taux (e.g. exonération for ALD, maternité, AT/MP), the ticket modérateur, participation forfaitaire and franchises, and the part AMC where a complémentaire is managed.
• Securisation — the FSE is signed with the CPS and the Carte Vitale; an unsecured (dégradé) mode requires the SCOR scanned supporting pieces.
• SCOR — attach scanned pièces justificatives (prescription, accord préalable) referenced from the FSE.

Worked example (outline)

PS = médecin secteur 1 (RPPS …), patient NIR=1 90 01 75 123 456 78 rang 1
Acte: consultation NGAP "G" le 2026-01-12, base 30,00 €
Taux AMO 70% → part AMO 21,00 €, ticket modérateur 9,00 €,
participation forfaitaire 2,00 € retenue ; part AMC 7,00 € (tiers payant mutuelle)
→ FSE B2 télétransmise via SESAM-Vitale ; retour de paiement par NOEMIE

Validation checklist

• Current Norme B2 inter-régime layout and SESAM-Vitale version used
• NIR + rang and caisse de rattachement read from the Carte Vitale; identity consistent
• Acts coded in CCAM / NGAP with correct base de remboursement and coefficient
• Taux AMO, ticket modérateur, participation forfaitaire and franchises applied
• Part AMO / part AMC split correct; exonérations (ALD, maternité, AT/MP) handled
• FSE secured with CPS + Carte Vitale; dégradé mode supported by SCOR pieces
• Lot/numéro de lot consistent; ready to reconcile against the NOEMIE return

Last updated: 2026-06-02 — CCAM/NGAP tariffs, reimbursement rates, franchises and the SESAM-Vitale/B2 versions change; confirm the current Norme B2 cahier des charges, tariffs, and rates against current Assurance Maladie (ameli.fr / sesam-vitale.fr) guidance before use.