The objectives of the National Health Insurance Fund (Caisse nationale d'assurance sociale (CNAM)) are expenditure control and improving the quality of care. Electronic transmission requirements and medical control prerogatives have made it necessary for the CNAM to invest in the automated processing of medical claim forms.

The main objective is the establishment of a decision-support system with a medical knowledge base which would take into account the specificities of each medical claim form.

The other objective of this project is to contribute the rationalization of medical prescriptions by tracking the behavior of health professionals and any deviations from predetermined benchmarks as well as identifying professionals with atypical activity.

By August 2014, 3,969,641 medical claim forms and 18,287,639 records had been processed using this system. A definitive assessment was made in 85% of the cases and 2,804,737 (15%) cases underwent medical controls.

In the second phase, this system will be applied to other benefits.