Guide · Conventionné doctors

CNAM billing: the doctor’s claim, from the visit to the transfer

A conventionné doctor is paid the CNAM’s share through the claim — the décompte d’honoraires, or “note d’honoraires” in the convention: the list of care given under tiers payant over a period of at most 90 days, with the co-pay (ticket modérateur) collected and the amount owed by the fund for each line. The claim must reach the reference centre within 90 days of its last act (before the end of February for December acts), and the CNAM pays it within 15 days of receiving it at most.

Updated October 12, 2026 · Every rule is cited from a document the CNAM distributes — first of all the sector convention of 3 November 2020, the most recent of the conventions. When in doubt, ask your reference centre.

The figures to know

The deadlines come from the sector convention for doctors in private practice of 3 November 2020; the tariffs from the schedule the CNAM publishes.

Figure	Rule	Text
90 days	Longest period one claim may cover	Convention (2020), art. 97
90 days	Filing deadline, counted from the claim’s last consultation or act	Convention (2020), art. 96
End of February	Filing deadline for claims covering December acts	Convention (2020), art. 96
15 days	Longest payment delay, counted from receipt of the claim	Convention (2020), art. 100
30 days	Electronic statement sent, counted from payment	Convention (2020), art. 101
80 % within 48 h	Advance on request when the claim is still unpaid 30 days after receipt	Convention (2020), art. 102
15 days	Delay after which a follow-up consultation that follows lab tests, investigations, the start of care or specialist care becomes billable again	Convention (2020), art. 57
30 · 45 · 50 DT	Office consultation with a GP, a specialist, a psychiatrist or a neurologist	Tarifs conventionnels (CNAM)

Which visits go on the claim?

Tiers-payant visits in the private track. The patient’s care card shows their option by colour: blue for the public track, yellow for the private track, green for the reimbursement system.

Private track (yellow card) — the patient has chosen a family doctor as their first point of care. Under tiers payant they pay the doctor only the co-pay; the CNAM pays the rest directly to the doctor, through the claim.
Reimbursement system (green card) — the doctor collects their full conventional fees and records them on the bulletin de soins; the patient is then reimbursed by the CNAM, within the coverage rates. Nothing goes on the claim.
Outside the care pathway — a private-track patient who sees another doctor without a referral from their family doctor pays the full conventional fee — except with a paediatrician, a gynaecologist or an ophthalmologist, with their APCI treating doctor for care linked to that condition, or in an emergency.

Source: Guide des procédures de prise en charge (CNAM, 2008 draft) · Convention (2020), art. 15, 61, 80 and 85

How is a tiers-payant visit split?

The visit’s total amount, at the conventional tariff, splits in two: the co-pay (ticket modérateur), which the patient pays the doctor directly, and the amount owed by the CNAM, which the claim requests. The coverage rate that sets this split is the base scheme’s; the co-pay collected is deducted from what the fund owes the doctor.

on every line: total amount = co-pay + amount owed by the CNAM;
in the transmission file, every amount is written in millimes;
the claim states the overall amount billed to the fund, also written out in words.

For care linked to an APCI — one of the 24 conditions on the list the CNAM publishes — given per protocol, with the APCI card shown: Avenant no. 7 of 2012 speaks of “exemption from the ticket modérateur” (art. 72 nouveau), and the 2020 convention refers to the terms and rates set by regulation (art. 10). These costs are excluded from the annual ceiling (art. 88).

iyada.tn counts in millimes and derives the CNAM share by subtraction — total amount minus co-pay — so the two shares always add up to the total exactly.

Source: Convention (2020), art. 10, 87, 88 and 95 · Avenant no. 7, art. 72 nouveau · Échange électronique de données

What to check before putting a visit on the claim?

Seven points, for every visit:

the patient shows a yellow (private-track) care card that is still valid, and their identity is checked;
you are their family doctor, or they were referred to you by them with a referral note, to attach to the claim — except paediatrician, gynaecologist, ophthalmologist, APCI treating doctor for care linked to the condition, and emergencies;
their annual ceiling is not reached: the family doctor stops billing the fund for ordinary-illness care from the date on the acknowledgement of receipt of the CNAM’s registered letter, and a specialist does not bill it when the referral note says “plafond atteint”;
for an APCI visit, the patient shows their APCI card — without it, only the ordinary-illness rules apply;
the visit is not a follow-up consultation after lab tests, further investigations, the start of a course of care or specialist care: such a visit is neither charged nor billed, and the rule lapses after 15 days;
a closely spaced consultation unrelated to the previous one remains billable, with a detailed medical certificate attached under confidential cover;
for an act requiring prior authorisation, a valid authorisation decision exists — without it, the cost falls on the patient; its prise-en-charge number is carried into the medecins.txt file.

Source: Convention (2020), art. 15, 34, 40, 42, 57, 61, 90 to 94 and 98 · Guide des procédures de prise en charge (CNAM, 2008 draft) · Échange électronique de données

What are the rules for a claim’s period?

Five rules set by the 2020 convention:

the period one claim covers may not exceed 90 days;
the claim reaches the reference centre within 90 days of its last consultation or act;
claims covering December acts are filed before the end of February of the following year;
a claim contains no act performed outside its own period;
its period may not overlap, even partly, that of any earlier claim.

If the filing deadline is missed, the doctor may turn to the regional joint committee. Avenant no. 7 of 2012 set the length and the deadline at 60 days; the 2020 convention raises both to 90.

Source: Convention (2020), art. 96, 97 and 99 · Avenant no. 7, art. 91

What does the claim form contain?

The CNAM supplies the model, titled “Note d’honoraires des consultations et des actes ambulatoires effectués par médecin conventionné dans le cadre du tiers payant”. At the top: the doctor, their convention code, the page and the period. Then one line per item of care:

Date des soins — the day the care was given.
I.U de l’assuré — the insured person’s unique identifier.
Identité du bénéficiaire — first name, status — insured person, spouse, child, dependent father or mother — and APCI code.
Acte effectué — act code and its cotation.
Montant total — the line’s conventional fee.
Ticket modérateur perçu de l’assuré — what the patient paid the doctor.
Montant à la charge de la CNAM — what the line requests from the fund.
Code conventionnel du médecin traitant — when the APCI patient was referred to you by their treating doctor; attach the liaison letter.

The model carries a “report” box, a “total à reporter” and a “total à payer”, and the claim is closed at that sum written out in words. A specialist seen within the care pathway attaches the family doctor’s referral note.

Source: Note d’honoraires (CNAM model) · Convention (2020), art. 95 and 98

What is the medecins.txt file?

It is the claim file the doctor sends to the CNAM regional centre they belong to, in the structure the CNAM publishes in “Échange électronique de données”. It holds three record types:

Record	Content
1 — Claim header	Doctor code, filing date, period start and end dates, claim reference, number of invoices, claim total, co-pay total and amount payable by the CNAM.
2 — Invoice	Invoice order, affiliation fund code, insured person’s registration number, kinship, patient rank, full name, date of birth, family doctor code (for specialists), prescription date, amounts and APCI code.
3 — Invoice line	Act code, amount, co-pay, prior authorisation (O or N) and prise-en-charge number.

amounts are written in millimes, in N(10) format;
dates are written AAAAMMJJ (year, month, day);
the doctor code is N(2) + N(8) + N(2), i.e. 12 digits;
kinship: 0 insured, 1 spouse, 2 child, 3 father, 4 mother;
fund code: 1 for CNSS, 2 for CNRPS.

Source: Échange électronique de données (CNAM)

How is the claim filed?

With the reference centre: directly, by registered post with acknowledgement of receipt, or by any other secure means to be agreed. The convention leaves the terms of electronic exchange to an avenant: ask your centre whether it accepts the medecins.txt file.

Source: Convention (2020), art. 81, 82 and 99

What happens after filing?

The CNAM pays the doctor by transfer, within 15 days of receiving the claim at most. Then:

within 30 days of payment, it sends an electronic statement: amount, date and reference of the transfer, and an explanatory note on the services paid or contested;
if the claim is still unpaid 30 days after receipt, you can request an advance of 80 % of its total amount, paid within 48 hours;
if payment is refused in full or in part, you can ask the regional joint committee to review the file.

Source: Convention (2020), art. 100 to 103

What iyada.tn does for you

iyada.tn builds the claim from visits already recorded, and applies the rules in this guide before filing:

the régime is chosen during the consultation, and the visit splits into co-pay and CNAM share, to the millime;
every visit is checked as of the date of care: card, entitlement, ceiling, APCI, prior authorisation, family doctor, follow-up consultation;
claims are numbered per year, and their period checked — length, overlap with an earlier claim — and, by iyada.tn’s choice, never straddling 31 December;
the note d’honoraires prints on the CNAM model, and the medecins.txt file is written to the published structure;
iyada.tn codes the reason for every contested service, links every correction to the original claim and reconciles the transfer line by line.

Try it free for 14 days See pricing

CNAM billing: frequently asked questions

Décompte, note d’honoraires, bordereau: the same document?

Décompte and note d’honoraires, yes: the 2020 convention uses both words (art. 95 to 99). “Bordereau” is everyday usage, absent from the CNAM’s texts. Either way, it is the list of tiers-payant care over a period that the CNAM pays the doctor for.

Is transmitting the medecins.txt file mandatory?

The 2020 convention does not require it: it provides for direct filing, registered post or any other secure means to be agreed (art. 99), and leaves electronic exchange to an avenant (art. 81 and 82). Your centre will tell you whether it accepts the file.

Can a follow-up consultation be billed?

No — neither to the patient nor to the fund — when it follows lab tests, further investigations, the start of a course of care or specialist care; the rule lapses after 15 days. A closely spaced consultation unrelated to the previous one is billable, with a detailed medical certificate under confidential cover (art. 57).

Does APCI care count toward the annual ceiling?

No: costs linked to a condition on the APCI list are excluded from the ceiling (art. 88), provided the patient shows their APCI card; without it, only the ordinary-illness rules apply (art. 40).

When is the deadline for December acts?

Before the end of February of the following year (art. 96). For other months, the deadline is 90 days after the claim’s last consultation or act.

What if the CNAM does not pay the claim?

The contractual deadline is 15 days after receipt (art. 100). If the claim is still unpaid 30 days after receipt, request an advance of 80 % of its total amount, paid within 48 hours (art. 102); if payment is refused in full or in part, the regional joint committee can review the file (art. 103).

The CNAM documents cited

All distributed by the CNAM. Between the 2020 convention and older texts, this guide follows the 2020 convention.

Échange électronique de données (medecins.txt file) — The complete medecins.txt file format: every field, its width and its type.
Avenant no. 7 (4 April 2012) — The follow-up recommendations for diabetic, hypertensive and ICC patients (annexe 1), and the APCI prescription form.
Convention sectorielle des médecins de libre pratique (3 November 2020) — What a claim must contain, its filing deadline and length, the no-overlap rule and the payment deadlines.
Tarifs conventionnels — Consultation tariffs and the value of the lettres-clés.
Note d’honoraires (CNAM model) — The official printed form and the exact order of its columns.
Liste des APCI — The chronic conditions covered in full, and their numbering.
Guide des procédures de prise en charge des assurés sociaux (draft, June 2008) — The care tracks, the colour of each card and APCI coverage.