esMD+Initiative

include component="page" wikiName="siframework" page="esMD SidebarRight" include component="page" wikiName="siframework" page="space.template.inc_contentleft_begin" include component="page" wikiName="siframework" page="esMD PageTabs" include component="page" wikiName="siframework" page="esMD initiative Announcements" =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)**
 * ~  ||~ **eDoC Harmonization Workgroup** ||~ **Electronic Determination of**
 * Coverage Workgroup** ||
 * > **Weekly Meeting** ||= **Currently On Hold** ||= **Currently On Hold** ||
 * > **Webex URL** ||= https://siframework1.webex.com/ ||= [] ||
 * > **Meeting Materials** ||= Click Here ||= Click Here ||

=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: 1) mail paper or 2) send a fax. The manual paper process is costly, time consuming and can delay proper claims processing on both the senders’ and receivers’ end.

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=
 * **esMD Workgroup** || **esMD Artifact Name and Link** || **Last Updated** || **Status** || **Link to Wiki Page** ||
 * Provider Profiles Authentication (PPA) || [[file:SIFramework_esMD_PPA_UC1.docx|PPA Use Case 1- Provider Registration with Payer]] || 2/1/13 || Consensus Approved || PPA Use Case 1 ||
 * Provider Profiles Authentication (PPA) || [[file:esMD Use Case 1 Implementation Guide V24 FINAL.docx|PPA Use Case 1- Provider Registration with Payer (Digital Signature Re-write)]] || 1/14/15 || Consensus Approved ||  ||
 * Provider Profiles Authentication (PPA) || [[file:esMD PPA Use Case 1 Implementation Guide Final v1.0.docx|PPA Use Case 1- Provider Registration with Payer]] || 2/1/13 || Consensus Approved || esMD Use Case 1 Implementation Guide Consensus Page ||
 * eMDR and Structured Content || [[file:SIFramework_esMD_UCR2_Sending eMDR_V1.0.docx|Secure Transportation and Structured Content of eMDRs]] || 5/30/13 || Consensus Approved || eMDR and Structured Content Use Case 2 ||
 * eMDR and Structured Content || [[file:esMD Use Case 2 Implementation Guide Final.docx|Secure Transportation and Structured Content of eMDRs: Implementation Guide]] || 2/1/13 || Consensus Approved || esMD Use Case 2 Implementation Guide ||
 * Provider Directory Guidance for esMD || [[file:Provider Directories Guidance for esMD Final v1.0 (2).docx|Provider Directory Query Guidance for esMD]] || 2/1/13 || Consensus Approved || Provider Directory Query Guidance for esMD ||
 * Author of Record Level 1- Digital Credentials SWG || [[file:SIFramework_esMD_AoR_SWG_Digital_Identities_V4.0 FINAL.docx|AoR L1 SWG Report: Digital Credential Management White Paper]] || 1/9/13 || Consensus Approved || esMD AoR L1 SWG 2 White Paper ||
 * Author of Record Level 1- Identity Proofing SWG || [[file:SIFramework_esMD_AoR_SWG_Identity_Proofing_V5.0 FINAL.docx|AoR L1 SWG Report: Identity Proofing White Paper]] || 1/9/13 || Consensus Approved || esMD AoR L1 SWG 2 White Paper ||
 * Author of Record Level 1- Digital Signatures and Delegation of Rights SWG || [[file:SIFramework_esMD_AoR_SWG_Digital_Signatures_and_Delegation_of_Rights_V3.0 FINAL.docx|AoR L1 SWG Report: Digital Signatures and Delegation of Rights White Paper]] || 1/9/13 || Consensus Approved || esMD AoR L1 SWG 3 White Paper ||
 * Author of Record Level 1 || [[file:SIFramework_esMD_AoR_UC_FINAL_2012-09-20.docx|AoR L1 Use Case]] || 2/22/13 || Consensus Approved || AoR L1 Use Case ||
 * Author of Record Level 1 || [[file:esMD AoR Level 1 Implementation Guide DRAFT v1.6.docx|AoR L1 IG]] || 2/22/13 || Consensus Approved || AoR L1 IG ||
 * Author of Record Level 1 || [[file:esMD AoR Level 1 Implementation Guide v5 FINAL.docx|AoR L1 IG (Digital Signature Re-write)]] || 1/7/15 || Consensus Approved ||  ||
 * Author of Record Level 2 || [[file:SIFramework_esMD_AoR_Level_2_UC_DRAFT V2 03.docx|AoR L2 Use Case]] || 3/20/13 || Consensus Approved || AoR L2 Use Case ||
 * Author of Record Level 2 || [[file:esMD AoR Level 2 IG V27 Consensus.docx|AoR L2 IG]] || 3/20/13 || Consensus Approved || AoR L2 IG ||
 * Author of Record Level 2 || [|HL7 Implementation Guide for CDA® Release 2: Digital Signatures and Delegation of Rights, Release 1] || 10/2014 || HL7 Draft Standard for Trial Use (DSTU) || HL7 Digital Signatures IG ||
 * Electronic Determination of Coverage (eDoC) || [[file:SIFramework_esMD_eDoC_UseCase_All Sections_2013-07-26 FINAL.docx|eDoC Use Case]] || 7/10/13 || Consensus Approved || esMD eDoC General Use Case ||
 * Electronic Determination of Coverage (eDoC) || [[file:SIFramework_esMD_eDoC_UseCase_PMD_USER_STORY_CONSENSUS_APPROVED_2013-10-30v2 (1).docx|eDoc Power Mobility Device (PMD) User Story]] || 10/30/13 || Consensus Approved || PMD User Story ||
 * Electronic Determination of Coverage (eDoC) || [[file:SIFramework_esMD_eDoC_UseCase_LLP_USER_STORY_CONSENSUS_APPROVED.docx|eDoC Lower Limb Prosthesis (LLP)]] || 1/8/14 || Consensus Approved || LLP User Story ||
 * Electronic Determination of Coverage (eDoC) || [[file:SIFramework_esMD_eDoC_UseCase_OCPO_USER_STORY_2015-03-18_FINAL.docx|eDoc Oxygen Providers and Portable Oxygen (OCPO) User Story]] || 3/31/15 || Consensus Approved || OCPO User Story ||
 * Electronic Determination of Coverage (eDoC) || [[file:SIFramework_esMD_eDoC_UseCase_HH_USER_STORY_FINAL_2015-10-21.docx|eDoC Home Health Services User Story]] || 10/21/2015 || Consensus Approved || Home Health User Story ||
 * Electronic Determination of Coverage (eDoC) || [[file:SIFramework_esMD_eDoC_SDC_FHIR_UseCase_All_Sections_2015-07-22v2.docx|eClinical Templates for Structured Data Capture on FHIR Use Case]] || 7/22/15 || In Progress || eClinical Templates for SDC on FHIR Use Case ||
 * Electronic Determination of Coverage (eDoC) || [|HL7 CDA® Release 2 Implementation Guide: Additional CDA R2 Templates – Clinical Documents for Payers Set 1, Release 1 – US Realm] || 8/2015 || HL7 Draft Standard for Trial Use (DSTU) || CDP1 Page ||
 * Electronic Determination of Coverage (eDoC) || [[file:esMD eDoC Companion Guide Order Validation 278 V10.docx|Companion Guide for Order Validation using the ASC X12 278 Transaction Set]] || 7/22/15 || Consensus Approved || esMD eDoC 278 Order Validation Companion Guide Consensus Review ||
 * Electronic Determination of Coverage (eDoC) || [[file:esMD eDoC Companion Guide Order Validation 837 V16.docx|Companion Guide for Order Validation using the ASC X12 837 Transaction Set]] || 7/22/15 || Consensus Approved || esMD eDoC 837 Order Validation Companion Guide Consensus Review ||
 * Electronic Determination of Coverage (eDoC) || [[file:esMD eDoC Companion Guide 275 (X275) V15.docx|Companion Guide with ASC X12N 275 (X275) Transaction Sets]] || 9/3/14 || Consensus Approved || esMD eDoC 275 (X275) Companion Guide Consensus ||
 * Electronic Determination of Coverage (eDoC) || [[file:esMD eDoC Companion Guide 275 (X278) V15.docx|Companion Guide with ASC X12N 275 (X278) Transaction Sets]] || 7/17/14 || Consensus Approved || esMD eDoC 275 (X278) Companion Guide Consensus ||
 * Electronic Determination of Coverage (eDoC) || [[file:esMD eDoC Companion Guide 278 V31.docx|Companion Guide with ASC X12N 278 Transaction Sets]] || 7/16/14 || Consensus Approved || esMD eDoC 278 Companion IG Consensus ||
 * Electronic Determination of Coverage (eDoC) || [[file:eCT-PMD Data Model v9.xlsx|eClinical Template PMD Data Model]] || 12/2/15 || In Progress ||  ||

=Overall esMD Initiative Timeline= include component="page" wikiName="siframework" page="esMD Contacts"

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include component="page" wikiName="siframework" page="space.template.inc_contentleft_end" Provider Profiles Authentication (Use Case 1