The purpose of the Pre-discovery phase is to create the Initiative Charter for review and approval by the S&I Steering Team. The Pre-Discovery phase is executed before the Call for Participation is provided to the broader Community of Interest. Learn more about the S&I Framework Processes & Guidelines and S&I Initiative Overview, Phases and Outputs.

Initiative Phase - Charter (Pre-Discovery)

Provider Profiles Authentication

Objective: Define the business requirements related to the registration process, compliant with CMS policies and FISMA guidelines, and determine how to securely send medical document request letters to registered providers. In addition to addressing requirements, this workgroup will also analyze and harmonize standards to support secure electronic sending of medical document request letters. Business requirements and standards will have a key focus on the needs of CMS and the CMS post-payment Review Contractors, while also considering options to enable re-use of the processes and standards by other Payers and Medicare partners.

Visit the following page to access the charter: Provider Profiles Authentication

eMDR and Structured Content

Objective: Define the business requirements related to the medical documentation request letters process, and analyze and harmonize standards that can be used to electronically send standards-based medical document request letters. Business requirements and standards will have a key focus on the needs of CMS and the CMS post-payment Review Contractors, while also considering options to enable re-use by other Payers and Medicare partners. 

Visit the following page to access the charter: eMDR and Structured Content

Author of Record

Objective:
The workgroup will conduct an environmental scan to understand what viable standards and practices are currently in place to support proof of authorship and digital signatures. With the knowledge obtained from the environmental scan, the workgroup will discuss and document requirements relevant to CMS and other Health Plans/Payers regarding signatures for submitted medical documentation. This will include vendors’ input with regards to what EHR systems can realistically support, and also include input from healthcare Providers to ensure the solution is not overly burdensome to healthcare Providers and healthcare Provider organizations. Additionally, the Provider Profiles Authentication and Structured Content/Secure Transport of the eMDR use cases will be supported in this workgroup by the following:

• Cryptographic (or equivalent) verification of all participants (Providers, Intermediaries, and Health Plans/Payers)
• Prevention of tampering
• Encryption of Patient Health Information (PHI) contained in the eMDR

This workgroup will define the Use Case and Functional Requirements, Analyze and Harmonize standards relevant to author-level signatures that support pilot implementations of the solutions, while taking into account the two Use Cases developed as part of the Standards and Interoperability Framework’s (S&I) esMD initiative. Business requirements and standards will focus on the needs of CMS and the CMS Review Contractors, while also considering options to enable re-use by other Health Plans/Payers.

Visit the following page to access the charter: Author of Record

Electronic Determination of Coverage

Visit the following page to access the charter: Electronic Determination of Coverage