clinical e-submission

Electronic Submission of Medical Documentation (esMD)

Currently, review contractors request medical documentation by sending a paper letter to the provider. The provider has two options for submitting the requested records either through mail paper or fax. Medicare’s Electronic Submission of Medical Documentation (esMD) pilot project gives some providers a new mechanism for submitting medical documentation to review contractors. A list of approved review contractors that will accept esMD transactions effective September 15, 2011 has been posted in CMS. Refer CMS for complete list of review contractors

The primary intent of esMD is to reduce provider costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors. A secondary goal of esMD is to reduce costs and time at review contractors. To send medical documentation electronically to review contractors, Medicare providers, including physicians, hospitals and suppliers, must obtain access to a CONNECT-compatible gateway.

*Certain larger providers, such as hospital chains, may choose to build their own gateway.

*Many providers may choose to obtain gateway services by entering into a contract or other arrangement with a Health Information Handler (HIH) that offers esMD gateway services.

What is a Health Information Handler (HIH)?

Any organization that handles health information on behalf of a provider is an HIH. Many providers already use HIHs to submit claims, provide electronic health record systems, etc. These HIHs are often called claim clearinghouses, release of information vendors, Health Information Exchanges, Electronic Health Record vendors, etc. Some HIHs are beginning to offer Electronic Submission of Medical Documentation (esMD) gateway services as well. Refer CMS for complete updates on HIH

Also see ‘esMD Graphic’

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