PPA+UC+2+-+Assumptions,+Pre+Conditions+and+Post+Conditions

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toc = The content within this page has been incorporated into the full Use Case posted here =


 * PPA Use Case 2 **

** Generic Assumptions **
The following assumptions apply to all user stories within this use case. Additional assumptions for CMS and Commercial payers are outlined in subsequent sections. The numbering of assumptions does not indicate that one is more important than the other.


 * 1) The eMDR will have structured content and meet the requirements set by the Structured Content Workgroup
 * 2) Provider (either directly or through their Agent) has a current valid ESI and has successfully registered to receive the eMDR as defined in Use Case 1.
 * 3) Payer or payer contractor will send the eMDR directly to or through the Provider’s Agent as determined by the current ESI information in the External Provider Directory
 * 4) When a provider does not have a current ESI, the provider will not receive an eMDR.
 * 5) All transactions will utilize industry accepted standards, where available.
 * 6) All transactions will have appropriate security to ensure data is transmitted with integrity, confidentiality, reliability; and with authentication of both the sender and receiver.
 * 7) All transactions will be delivered in a timely manner.
 * 8) The transport of content and required data elements will be discussed during the harmonization phase.
 * 9) It is the responsibility of an Agent or Gateway to ensure reliability and consistency of any transformation of information.

** ‍ **** CMS User Story Additional Assumptions **

 * 1) esMD Gateway is used by CMS and its contractors and will support the activities related to eMDR transactions.
 * 2) All transactions will use NwHIN Exchange.
 * 3) CMS requires that all providers who wish to receive eMDRs to use this process.
 * 4) CMS esMD Gateway requires Providers to have access to a CMS compliant gateway.

** Commercial Payer User Story Additional Assumptions **

 * 1) All Generic Assumptions apply for Commercial Payer.
 * 2) Commercial payers may or may not use an Agent or another Intermediary to send eMDRs.

** Generic Pre-Conditions **

 * 1) Payer has authenticated the updated and valid ESI of the Provider as set by PPA Use Case 1.
 * 2) Provider or Agent has successfully registered and requested the Payer to send the medical documentation request electronically.
 * 3) Provider entity or Agent supports the required transaction and payload standards for the eMDR transactions.
 * 4) Payer internal information systems are established to send the eMDR.
 * 5) eMDR follows the standards of Structured Content established.
 * 6) Providers or Agents can receive an eMDR and acknowledge the receipt of eMDR.
 * 7) Provider registration information is maintained by the payer and available for use by the payer or other users of the provider registration system.
 * 8) Payers will send eMDRs to the current updated and valid ESI for a registered provider at the time of transmission.
 * 9) Providers and Agents will maintain and update current ESI information.

** CMS and Commercial Payer User Story Additional Pre-Conditions **

 * 1) None. All Generic Pre-Conditions apply for CMS and Commercial Payer User Story

** ‍ **** Generic Post Conditions **

 * 1) Providers and Agents will maintain the ability to receive eMDRs after successful registration unless terminated through established mechanisms.

** CMS and Commercial Payer User Story Additional Pre-Conditions **

 * 1) None. All Generic Post-Conditions apply for CMS and Commercial Payer User Story

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