Parse French Health Insurance Return Message (NOEMIE 580)

Skill: Parse a NOEMIE payment/rejection return into reconciliation data

Region: France Category: Health care Does: Takes a NOEMIE return message (norme NOEMIE 580 — retour RSP) received from the Assurance Maladie and parses it into reconciliation data (paiements, rejets/RSP, signalements) matched against the originally télétransmitted feuilles de soins électroniques (FSE) in norme B2. Spec: Assurance Maladie (CNAM) — NOEMIE 580 return / RSP message format (current version)

NOEMIE (Norme Ouverte d'Échange entre la Maladie et les Intervenants Extérieurs) carries the AMO's reply to télétransmitted FSE/DRE flows: amounts paid, rejected lots/invoices and the reason codes (RSP — retour signalement et paiement). Parsing reconciles expected vs paid amounts. This is a parse skill: it reads an inbound message. Field names below follow the NOEMIE 580 / RSP layout, not a verbatim spec.

When this applies

• A health professional (PS) or third-party (organisme concentrateur) has télétransmitted FSE in norme B2 via SESAM-Vitale and now receives the AMO return.
• You need to know which invoices (factures/lots) were paid, rejected, or signalled, the amounts, payment dates and bank references, to clear receivables and re-bill rejects.
• Applies to both AMO returns and, by extension, AMC/complementary returns where a NOEMIE-style flow is used (tiers payant).

Structure (NOEMIE 580 → reconciliation data)

En-tête flux: organisme émetteur (caisse), PS destinataire (RPPS/AM/FINESS), date
Bordereau / virement: référence du virement, montant total payé, date de paiement
Boucle facture / FSE:
   numéro de lot et numéro de facture (rattachement à la FSE B2 émise)
   NIR de l'assuré (+ rang), date de soins
   montant demandé vs montant payé (part AMO)
   code rejet / signalement (RSP) + libellé, ligne d'acte concernée (CCAM/NGAP)
Récapitulatif: nb factures payées / rejetées, total payé, total rejeté

Data rules

• Match keys: lot + facture numbers (and NIR/date de soins) link each NOEMIE line back to the emitted FSE B2 so paid/rejected status is attributed correctly.
• Reason/RSP codes classify rejects (e.g. droits clos, NIR erroné, acte non remboursable, double facturation); map each to a re-bill or write-off action.
• Reconcile montant payé against montant demandé; differences arise from ticket modérateur, participation forfaitaire, franchises or partial rejection.
• Amounts in EUR; the référence de virement ties the NOEMIE return to the actual bank payment for cash reconciliation.
• Returns are pulled from the SESAM-Vitale/CPAM exchange channel (FSV / concentrateur); each return references the original télétransmission.

Worked example (outline)

En-tête: caisse 751, PS RPPS 10100000001, date retour 2026-05-20
Virement réf VIR2026051200 : total payé 138.40, date 2026-05-21
Facture lot 042 / fact 0007 : NIR 1 85 05 75 116 084, soins 2026-05-02,
   demandé 25.00, payé 17.50 (RSP: ticket modérateur 30%)
Facture lot 042 / fact 0008 : demandé 23.00, payé 0.00, rejet code 21 (droits clos)
Récap: 1 payée, 1 rejetée; total payé 17.50

Rejected invoice 0008 is queued for correction and re-télétransmission; paid lines clear the FSE receivable.

Validation checklist

• Émetteur (caisse) and destinataire (PS RPPS/AM/FINESS) identified
• Each NOEMIE line matched to an emitted FSE B2 by lot + facture (and NIR/date)
• Paiements vs rejets separated; RSP reason codes decoded to actions
• Montant payé reconciled to montant demandé (ticket modérateur / franchises explained)
• Virement reference reconciled to the actual bank payment in EUR
• Rejects routed for correction and re-télétransmission
• Return pulled from the correct SESAM-Vitale/AMO exchange channel

Last updated: 2026-06-04 — confirm the current NOEMIE 580 / RSP return layout, reason codes, and reconciliation rules against current Assurance Maladie (ameli.fr) and SESAM-Vitale guidance before use.