›› Procedures requiring prior agreement

Procedures that are subject to prior approval

This is a procedure for assessing the necessity of prescribed procedures or supplies. This formality applies to certain procedures listed in the General Nomenclature of Professional Procedures or in the case of analogous coding.

When the procedure is subject to this formality, a request for prior approval must be sent to the Medical Control before performing the procedure. This request must be completed and signed by the practitioner who will perform the procedure. When the procedure is to be performed by a medical assistant, the request for prior approval must be submitted together with the medical prescription for the procedure.

Requests for prior approval are made on forms that follow the rules set by the National Social Insurance Fund.

In an emergency, the doctor does the procedure but still fills out the form, writing ‘Emergency procedure’ on it. The file is sent to the Medical control.

When the practitioner wishes to perform a procedure that is not listed in the General Nomenclature of Professional Procedures, he must assign it a rating by comparing it to the most similar procedure that is listed. In this case, the performance of this procedure is subject to the prior agreement procedure.

The Fund’s response must be sent to the patient or practitioner, as applicable, no later than the tenth day following the submission of the request. If no response is received within this period, consent is deemed to have been given.

However, in the case of assimilation rating and if no response is received within ten days, this is equivalent to a implicit refusal of the assimilation request.