CMS+esMD

toc CMS is preparing to conduct a pilot which will leverage Nationwide Health Information Network to allow providers to submit medical documentation to CMS in support of claims as part of post-payment auditing.

**Work Products **
[|ESMD_X12_Service_Defintion _02232011_v1.doc] ESMD_Profile_275_v0_0_4_24_X12_Draft_Final_dj.doc [|ESMD_Profile_275_v0_0_4_24.docx]
 * **Work Product** || **Status** || **Draft Versions** || **Date** || **Work In-Progress** ||
 * esMD X12 Service Definition (275) || Completed || Current Draft:

Past Drafts: [|ESMD_Profile_275_v0_0_4_23.docx] [|ESMD_Profile_275_v0_0_4_22.docx] [|ESMD_Profile_275_v0_0_4_21.docx] [|ESMD_Profile_275_v0_0_4_20.docx] [|ESMD_Profile_275_v0_0_4_19.docx] [|ESMD_Profile_275_v0_0_4_18.docx] [|ESMD_Profile_275_v0_0_4_17.docx] [|ESMD_Profile_275_v0_0_4_16.docx] [|ESMD_Profile_275_v0_0_4_15.docx] [|ESMD_Profile_275_v0_0_4_14.docx] [|ESMD_Profile_275_v0_0_4_13.docx] [|ESMD_Profile_275_v0_0_4_12.docx] [|ESMD_Profile_275_v0_0_4_11.docx] [|ESMD_Profile_275_v0_0_4_10.docx] [|ESMD_Profile_275_v0_0_4_9.docx] [|ESMD_Profile_275_v0_0_4_8.docx] [|ESMD_Profile_275_v0_0_4_7.docx] [|ESMD_Profile_275_v0_0_4_6.docx] [|ESMD_Profile_275_v0_0_4_5.docx] [|ESMD_Profile_275_v0_0_4 4.docx] ESMD Profile 275 v0 0 4.1 [|ESMD Profile 275 v0 0 3.docx] [|ESMD Profile 275 v0.0.1.docx] [|ESMD Profile V0.0.4] || **Updated** - 1/9/2011 || Open Issues Use Case (NIEM documentation) || [|ESMD Profile v016_05162011_Profiles.doc]
 * esMD XDR Profile || New draft out for Review || Current Draft:

__Final:__ __[|ESMD Profile v10.docx]__

__Past Drafts:__ __[|ESMD Profile v013__03142011_Profiles.doc]__ [|esmd_XDR_Service_Defintion_02232011_v1-1.doc] [|ESMD Profile v11.1_02162011_XDR_Draft_Final_dj.doc] __[|ESMD Profile v11.1_02162011_Track changes-3.doc]__ __[|ESMD Profile v11_01102011_With_Trackchanges.doc]__ __[|ESMD Profile v11__01102011_Without_Trackchanges.doc]__ __[|ESMD_Profile_V0.0.9]__ __[|ESMD_Profile_V0.0.8]__ __[|ESMD_Profile_V0.0.7]__ __[|ESMD Profile V0.0.5]__ || **Updated** 03/21/2011 ||  || [|ESMD_X12_Service_Defintion _05242011_v0.4.28.doc]
 * esMD X12 Service Definitions for Progress Notes & Orders || Review || Current Draft:

Past Drafts: [|ESMD_X12_Service_Defintion _04252011_v0.0.4.27.doc] [|ESMD_X12_Service_Defintion _03152011_v3.doc] [|ESMD_X12_Service_Defintion _03142011_v2.doc] || **Updated** 6/1/2011 ||  || [|Trader Partner Profile_ESMD_X12_05182011_v0.0.1.doc]
 * esMD X12 Trader Partner Agreement Profile || Review || Current Draft:

Past Drafts: || Updated 5/23/2011 ||  || [|ESMD_X12_58 Digital Signature Service_Defintion V0 0 1 DJ (3).doc] || Updated 5/25/2011 ||  || Example of new Nationwide Health Information Network Specifications Factory documentation formats__
 * esMD X12.58 Service Definitions for Digital Signatures || Review || Current Draft:

[|AuthorizationFramework_v2 0 1 1.docx] [|AuthorizationFramework_v2 0 1 1.xlsx]

**Action Items and Key Decisions:**
esMD Action Items

**Reference Materials:**

 * [|CDAR2AIS0004R030_Clinical Reports 030211.doc]
 * [|Proposed_CMS_esMD_Enrollment Agreement_05022011_v5.pdf]
 * 838_Trading Partner_Profile - Contact Donna Jones if you are a member of the esMD Spec Factory work group to receive an e-mail copy.
 * 838_Trading Partner_Profile_Full Version -Contact Donna Jones if you are a member of the esMD Spec Factory work group to receive an e-mail copy.
 * X12.58_Security_Structures - Contact Donna Jones if you are a member of the essMD Spec Factory work group to receive an e-mail copy.
 * [|EDI Enrollment Agreement Form.mht]
 * [|Development Request For]
 * [|PhysicianOdersMetadata V12Mar09_dj.xls]
 * [|Introduction to CMS esMD project (powerpoint)]
 * HITSP Materials Regarding 270/271 Eligibilty Transaction Set
 * [|Nationwide Health Information Network Medicaid Eligibility Verification Specification v1.0]
 * [|c62 AIS Gap Analysis.xlsx]
 * [|HITSP Links.doc]
 * [|Addenda_X098A1_02032011 (2).pdf]
 * [|4010_x098_02032011.pdf]
 * [|JC_ADMC_request_form.pdf]
 * [|NHIN_DocumentSubmissionEmergencePilotSpecification_v1 1 0.pdf]
 * [|NHIN_AdministrativeDistributionEmergencePilotSpecification_v1.pdf]

**Digital Signatures**
>>
 * Below is a link to a number of titles from the American Health Information Management Association’s “Body of Knowledge” They can be accessed using the link below, then putting “Electronic Signature” in the search box.
 * []
 * The State of California’s directives and regulatory requirements for electronic signatures. The site itself also has a link to the actual regulations.
 * []
 * Signing CDA documents
 * [|signing-cda-documents.html]
 * Healthcare use of x509 and PKI is trust worthy when managed
 * [|healthcare-use-of-x509-and-pki-is-trust.html]
 * SSL is not broken, Browser based PKI is
 * [|ssl-is-not-broken-browser-based-pki-is.html]

**Physicians Orders**

 * C83 HITSP CDA Content Modules Component (see page 53, 5th row- Orders Information, v2.0.1)
 * [|HITSP_v2.0.1_2010_C83_-_CDA_Content_Modules.pdf]
 * TP43 HITSP Medication Orders Transaction Package
 * [|HITSP_V1.2_2009_TP43_-_Medication_Orders.pdf]
 * HL7 Additional Information Specification Implementation Guide
 * [|CDAR2AIS0000R030_ImplementationGuideDraft.pdf]
 * Military Health System/DOD for physician orders
 * [|PhysicianOdersMetadata V12Mar09_dj.xls]
 * List of HL7 Standards for Attachments
 * [|HL7 Guides for attachments.pdf]

**Progress Notes**

 * HL7 Additional Information Specification Implementation Guide
 * [|CDAR2AIS0000R030_ImplementationGuideDraft.pdf]
 * C32 HITSP Summary Documents Using HL7 Continuity of Care Document (CCD) Component
 * [|HITSP_V2.5_2009_C32_-_Summary_Documents_Using_CCD.pdf]
 * C48 HITSP Encounter document Using IHE Medical Summary (XDS-MS) (Discharge Summary)
 * [|HITSP_V2.5_2009_C48_-_Encounte__Document.pdf]
 * C83 HITSP CDA Content Modules Component (page 22)
 * [|HITSP_v2.0.1_2010_C83_-_CDA_Content_Modules.pdf]
 * C68 HITSP Patient Health Plan authorization Request and Response Transaction
 * [|HITSP_V2.0_2010_T68_-_Patient_Health_Plan_Authorization_Request_and_Response.pdf]
 * List of HL7 Standards for Attachments
 * [|HL7 Guides for attachments.pdf]

**Appeals**

 * N/A

**Prior Authorization**

 * C68 HITSP Patient Health Plan authorization Request and Response Transaction
 * [|HITSP_V2.0_2010_T68_-_Patient_Health_Plan_Authorization_Request_and_Response.pdf]
 * T79 Pharmacy to Health Plan Authorization Request & Response
 * [|HITSP_V1.1_2009_T79_-_Pharmacy_to_Health_Plan_Authorization_Request_and_Response.pdf]
 * HL7 Additional Information Specification Implementation Guide
 * [|CDAR2AIS0000R030_ImplementationGuideDraft.pdf]
 * 278 May be available from Gary Beatty.
 * [|dme_mac_jurisdiction_A_sm_v004.pdf]
 * [|DME_MAC_jurisdiction_B_132_1209_suppliermanualupdate_ch_09.pdf]
 * [|JC_ADMC_request_form.pdf]
 * [|DME_MAC_jurisdiction_D_eula.php.htm]
 * HITSP Prior Auth specification
 * http://wiki.hitsp.org/docs/T79/T79-1.html

**Timeline:**
esMD Phase 1 - 275 Extension Development Effort:
 * June 2, 2010 - **Spec Factory kick-off meeting**

esMD Phase 1 Development Effort:
 * **March 29, 2010 -** CMS esMD request prioritized by NTC
 * **April 13, 2010 -** Spec Factory kick-off meeting
 * **May 7, 2010 -** Finalize new Nationwide Health Information Network specifications/upates to existing Nationwide Health Information Network specifications to support esMD

__**Business Scenario Description:**__
CMS seeks to provide an electronic mechanism for providers to submit imaged medical documentation to CMS, demonstrated through CMS' Electronic Submission of Medical Documentation (esMD) pilot. Phase I of esMD is limited to a push exchange of information one-way from a data trading partner, termed an HIH by the esMD project, to esMD using unstructured document attachments. Each message will contain identifiable patient information for only one patient. At the CMS end, requests for documentation are identified by RAC IDs and claim numbers, which are unique to a patient, but not by unique patient IDs (that means that one patient might have multiple claim numbers, but one claim number will correspond to one and only one patient). We would like to perform document validation – which might include whether the document is well-formed and whether the claim number is recognized and corresponding to a request for documentation. __**Transaction:**__ For detailed transaction requirements and related standards: esMD Transaction Requirements

**__Content:__** For detailed content requirements and related standards: esMD Content Requirements __**Actors: **__
 * **Actor Name** || **Actor Description** ||
 * Initiating Entity || Entity sending health information for a specific patient ||
 * Receiving Entity || Entity receiving health information for a specific patient ||

**__Use Cases:__**

 * **Use Case Name** || **Use Case Description** ||
 * Send Health Information || Initiating Entity sends health information for a specific patient to a receiving entity. ||