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HL7 CDP1 IG Community Meeting
The community meetings for the HL7 Complete Documents for Payers Set 1 will be held every Friday at 2PM ET.

esMD Pilots
Information on esMD Pilots is now available here: esMD Pilots.
To register as a pilot for esMD, please visit: esMD Pilots Registration Page.
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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/
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)
PPA Use Case 1- Provider Registration with Payer
2/1/13
Consensus Approved
PPA Use Case 1
Provider Profiles Authentication (PPA)
PPA Use Case 1- Provider Registration with Payer (Digital Signature Re-write)
1/14/15
Consensus Approved

Provider Profiles Authentication (PPA)
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
Secure Transportation and Structured Content of eMDRs
5/30/13
Consensus Approved
eMDR and Structured Content Use Case 2
eMDR and Structured Content
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
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
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
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
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
AoR L1 Use Case
2/22/13
Consensus Approved
AoR L1 Use Case
Author of Record Level 1
AoR L1 IG
2/22/13
Consensus Approved
AoR L1 IG
Author of Record Level 1
AoR L1 IG (Digital Signature Re-write)
1/7/15
Consensus Approved

Author of Record Level 2
AoR L2 Use Case
3/20/13
Consensus Approved
AoR L2 Use Case
Author of Record Level 2
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)
eDoC Use Case
7/10/13
Consensus Approved
esMD eDoC General Use Case
Electronic Determination of Coverage (eDoC)
eDoc Power Mobility Device (PMD) User Story
10/30/13
Consensus Approved
PMD User Story
Electronic Determination of Coverage (eDoC)
eDoC Lower Limb Prosthesis (LLP)
1/8/14
Consensus Approved
LLP User Story
Electronic Determination of Coverage (eDoC)
eDoc Oxygen Providers and Portable Oxygen (OCPO) User Story
3/31/15
Consensus Approved
OCPO User Story
Electronic Determination of Coverage (eDoC)
eDoC Home Health Services User Story
10/21/2015
Consensus Approved
Home Health User Story
Electronic Determination of Coverage (eDoC)
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)
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)
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)
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)
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)
Companion Guide with ASC X12N 278 Transaction Sets
7/16/14
Consensus Approved
esMD eDoC 278 Companion IG Consensus
Electronic Determination of Coverage (eDoC)
eClinical Template PMD Data Model
12/2/15
In Progress


Overall esMD Initiative Timeline

esMD timeline Jan 2016.png

EMDI Leads and Support

Name
Role
Contact Information
Bob Dieterle
HL7 Standards and Specifications Lead
Rdieterle@enablecare.us
Melanie Edwards
CMS Lead/Co-Workgroup Lead
Melanie.Edwards@cms.hhs.gov
Shailesh Patel
Project Manager
Spatel@scopeinfotechinc.com
Pallavi Talekar
Pilot Lead
Ptalekar@scopeinfotechinc.com
Ray Wilkerson
Project Support
Rwilkerson@scopeinfotechinc.com
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Provider Profiles Authentication (Use Case 1