esMD Initiative

HL7 CDP1 IG Community Meeting
The community meetings for the HL7 Complete Documents for Payers Set 1 will be held every Friday at 2PM ET.

esMD Pilots
Information on esMD Pilots is now available here: esMD Pilots.
To register as a pilot for esMD, please visit: esMD Pilots Registration Page.
Edit Announcements Table

esMD Meeting Schedule (at-a-glance)

For more detailed meeting information, agendas, attendance, and notes, please visit the Initiative Workgroup Meetings page (located in the main menu above)

Initiative Overview

Healthcare payers frequently request that providers submit additional medical documentation for a specific claim to support claims processing and other administrative functions, such as the identification of improper payments. Currently, Medicare Review Contractors request approximately 2 million medical documents per year by mailing a paper request letter via US Postal Service to healthcare providers. Until recently, providers had only two options for submitting the requested records: mailing a letter or sending a fax. The manual paper process is costly, time consuming and can delay proper claims processing on both the senders’ and receivers’ ends.

As of September 15, 2011, a pilot group of Health Information Handlers (HIHs) and Medicare Review Contractors began accepting electronic submissions from providers as part of the first phase of esMD. These electronic submissions consist of an unstructured PDF format of a scanned image, with an X12 wrapper. There is added value to CMS, Commercial Payers, and Providers in pursuing additional automation of the electronic request and submissions process.

CMS continues to investigate additional capabilities of electronic submission of medical documentation. The next release, esMD Phase 2, is planned for January 2013, which will enable Medicare Review Contractors to send electronic medical request letters, eliminating the need to send the paper letters via mail. CMS has joined the Standards & Interoperability (S&I) Framework to accomplish their immediate goals for Phase 2, and to address their long-term requirement for replacement of wet signatures by using the open forum, community expertise, and reusable assets that the S&I Framework provides.

The key objectives for the S&I Framework esMD Initiative include:

• Identify a standards-based machine-interoperable electronic format to replace the current paper version of the medical document request letter sent to providers
• Develop a registration process to allow Providers to sign up to receive electronic medical documentation request letters from CMS Review Contractors
• Identify a secure method of sending medical documentation request letters from CMS review contractors to providers
• Identify a solution that will enable an electronic replacement of wet signatures, for medical documents submitted from providers to CMS

esMD Artifacts

Overall esMD Initiative Timeline

esMD Initiative

HL7 CDP1 IG Community Meeting
The community meetings for the HL7 Complete Documents for Payers Set 1 will be held every Friday at 2PM ET.

esMD Pilots
Information on esMD Pilots is now available here: esMD Pilots.
To register as a pilot for esMD, please visit: esMD Pilots Registration Page.
Edit Announcements Table

esMD Meeting Schedule (at-a-glance)

For more detailed meeting information, agendas, attendance, and notes, please visit the Initiative Workgroup Meetings page (located in the main menu above)

Initiative Overview

Healthcare payers frequently request that providers submit additional medical documentation for a specific claim to support claims processing and other administrative functions, such as the identification of improper payments. Currently, Medicare Review Contractors request approximately 2 million medical documents per year by mailing a paper request letter via US Postal Service to healthcare providers. Until recently, providers had only two options for submitting the requested records: mailing a letter or sending a fax. The manual paper process is costly, time consuming and can delay proper claims processing on both the senders’ and receivers’ ends.

As of September 15, 2011, a pilot group of Health Information Handlers (HIHs) and Medicare Review Contractors began accepting electronic submissions from providers as part of the first phase of esMD. These electronic submissions consist of an unstructured PDF format of a scanned image, with an X12 wrapper. There is added value to CMS, Commercial Payers, and Providers in pursuing additional automation of the electronic request and submissions process.

CMS continues to investigate additional capabilities of electronic submission of medical documentation. The next release, esMD Phase 2, is planned for January 2013, which will enable Medicare Review Contractors to send electronic medical request letters, eliminating the need to send the paper letters via mail. CMS has joined the Standards & Interoperability (S&I) Framework to accomplish their immediate goals for Phase 2, and to address their long-term requirement for replacement of wet signatures by using the open forum, community expertise, and reusable assets that the S&I Framework provides.

The key objectives for the S&I Framework esMD Initiative include:

• Identify a standards-based machine-interoperable electronic format to replace the current paper version of the medical document request letter sent to providers
• Develop a registration process to allow Providers to sign up to receive electronic medical documentation request letters from CMS Review Contractors
• Identify a secure method of sending medical documentation request letters from CMS review contractors to providers
• Identify a solution that will enable an electronic replacement of wet signatures, for medical documents submitted from providers to CMS

esMD Artifacts

Overall esMD Initiative Timeline