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CMS Research, Statistics, Data & Systems- Electronic Submission of Medical Documentation (esMD)- esMD for Health Information Handlers

Guidance for CMS Research, Statistics, Data & Systems regarding Electronic Submission of Medical Documentation (esMD) for Health Information Handlers.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 23, 2020

Health Information Handlers (HIHs) can provide software and communication services to help providers and suppliers securely exchange documentation with Review contractors using the Electronic Submission of Medical Documentation (esMD) System.

To become a certified HIH, companies must submit a request to the esMD Helpdesk and follow the esMD Onboarding Steps (PDF). Once approved, HIHs have two options to complete their set up:

  1. Build a compliant and CONNECT-compatible gateway
  2. Use Reference Implementation and Outreach Coordinator (RIOC) software.

Refer to slides 14 and 15 of the Introducing esMD to New Providers, RCs, and HIHs (PDF) for more details.

CMS recommends that HIHs ensure they have an experienced technical staff to expedite all testing tasks and review the esMD HIH Implementation Guide (PDF) and the X12 Transaction Companion Guide and Codes (PDF). Knowledge of CONNECT software and the Simple Object Access Process (SOAP) User Interface (UI) tool is also helpful.

Current Release Documents

Release specific documents that are sent via notification by the esMD Help Desk will also be published on the website. The esMD technical team distributes the following documents during the course of the release:

Current Release Information (October 2021 Release)

Note: This section will have the documents for the upcoming release. After updates are available, all documents related to that release will be removed as all the details will become part of the HIH Implementation Guide (PDF).

Contact the esMD Help Desk for additional assistance.

View the Program Integrity Manual Section 3.2.3.4 – “Additional Documentation Request Required and Optional Elements” (PDF) in addition to the associated Program Integrity Manual Exhibits 46.1 – 46.5 (PDF).

Frequently Asked Questions

What are the steps for a new HIH to onboard esMD?

HIHs must first sign an agreement with CMS and then submit a request using the documents below:

How can an HIH change their existing information?

Download and submit the Change Request – Certificate Renewal Form (PDF).

What Version of CONNECT does CMS plan to use?

CMS is using CONNECT version 4.4 in its current release of the CMS esMD gateway.

Where can I find the esMD HIH Implementation Guide and the Program Reason Codes of all the supported PA Programs?

Please check the website periodically for the latest version of the esMD HIH Implementation Guide (PDF) and Review Reason Codes and Statements.

What is the correct Claim Identifier (Claim ID) format and how should it be submitted?

Find guidance on Claim ID format on Page 25 of the HIH Implementation Guide (PDF).

Is there list of RC point of contacts (POCs) and any relevant information that can be used as reference by HIHs?

Please refer to RC POC for HIH Use (PDF) to contact the RCs. RC Organization ID (OID) Reference (PDF) should be used by HIHs in various transactions.

Where can the X12 transaction and related information be found?

All the details related to the X12 (278/275) transactions can be found in various companion guides and documents.

How can an HIH submit a question to esMD?

The best way to address issues with esMD is to create an incident ticket with the esMD Help Desk.

What is Medicare Fee-for-Service program?

Visit Medicare Fee-for-Service Compliance Programs for more information.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the Section 508 Help Desk.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.