Electronic+Submission+of+Medical+Documentation+Quickstart+Page



On this Quickstart page, you will find resources, artifacts, and key deliverables pertaining to the esMD Initiative.

What is an MDR?
An MDR or medical documentation request is made when a payer wishes to audit a healthcare claim. The payer requests that the provider submit additional medical documentation for a specific claim. This documentation is used 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.

How does the esMD initiative improve MDRs?
CMS and other appropriate payers need a standardized, implementable, machine-interoperable electronic solution to reduce the time, expense, and paper required in current manual processing of both medical documentation request letters and the relevant claims attachments exchanged between providers to payers. To support the electronic sending of medical document request letters and the electronic submission of medical documentation, the following solutions will be required:
 * 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 enables an electronic replacement of wet signatures for medical documents submitted by providers to CMS

Background on the S&I Framework esMD Initiative
If you are looking to get started with the esMD initiative, start by reading some of the background materials produced. This will give you a good start at understanding the challenges of developing electronic medical documentation requests, the approach taken by the S&I Framework to address these challenges, and the building blocks necessary as an implementer.

**I want to understand the context of this initiative and what community-led decisions were made** (click below for documents and links): - Use Case 1 is focused on developing the process by which Providers register with Payers to receive MDRs electronically. - Use Case 2 is focused on the processes by which a Payer will securely and reliably send an eMDR to a payer. || Use Case 1: Harmonization
 * = **Type** || **Workstream** || **Overview** || **Status** ||~  ||
 * = [[image:wiki_icon.png link="esMD - Provider Profiles Authentication"]] || Providers Profile Authentication (PPA) || The PPA workstream consists of two Use Cases:

Use Case 2: Under Development ||~  || **I want to build an architecture that supports eMDRs** (click below for documents and links):
 * = [[image:wiki_icon.png link="esMD - Structured Content"]] || Structured Content || The Structured Content workstream is researching and developing an electronic alternative to a paper MDR. This workstream and PPA Use Case 2 are under development together and will result in a single use case document. || Under Development ||~  ||
 * = [[image:wiki_icon.png link="esMD - Author of Record"]] || Author of Record (AoR) || The Author of Record worksteam will investigate and recommend options to replace provider wet signatures on paper clinical documents with an electronic solution that provides document level proof of authorship. This workstream is on hold until PPA Use Case 2 and Structured Content are near completion. || On Hold ||~  ||
 * = **Type** || **Name** || **Description** ||= **Version** ||~  ||
 * = [[image:excel_icon.png link="@https://docs.google.com/spreadsheet/ccc?key=0ApW4Ox66ml2IdHF2bWJ4MmVtRTU1SnNKVDZmS0JRMVE"]] || esMD PPA Use Case 1 Data Model || This data model provides details about the data elements used in the registration request and response transactions. ||= Under Development ||~  ||

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