PPA+User+Story+2+-+Secure+Sending+of+MDR+Letter

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

**Scenario 1**

The payer or payer contractor sends a payer compliant electronic Medical Document Request (eMDR) to an eMDR Consumer for additional information to support review of a claim.

**Generic User Story**

The Provider Profile Authentication (PPA) work stream is a two part process. The first part is covered in a separate Use Case that focuses on a provider or provider organization sending a registration request to a payer entity in order to receive the Medical Documentation Request electronically (eMDR). The below user story focuses on the sending of the eMDR to an eMDR Consumer. A payer or payer contractor identifies a need for supporting documentation for a claim from a provider. The payer or payer contractor checks the payer’s internal system to verify whether a provider has registered to receive eMDRs prior to sending a request.

If it is determined that the provider is successfully registered within the payer internal system, either the payer or payer contractor sends an Electronic Services Information (ESI) query request to the External Provider Directory to retrieve a provider's current ESI. The External Provider Directory responds to the payer or payer contractor’s ESI query with the provider’s current ESI information.

The payer or payer contractor may send the eMDR directly or through a Gateway to the provider or provider’s Agent. If the payer does not send an eMDR directly to the provider, a payer contractor sends the eMDR on their behalf.

The provider will receive an eMDR if they are successfully registered and have the current ESI information. If the provider is not successfully registered or does not have the appropriate ESI information; they will not receive an eMDR.

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