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Which HIHs Offer esMD Gateway Services to Providers?

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 perform functions such as submitting claims and providing electronic health record systems. Some HIHs are beginning to offer Electronic Submission of Medical Documentation (esMD) gateway services as well. These HIHs are often referred to by a variety of names including Claim Clearinghouses, Release of Information vendors, Health Information Exchanges, and Electronic Health Record vendors. 

The following table lists the HIHs that are certified by the Centers for Medicare & Medicaid Services (CMS) to send responses to medical documentation requests. Additionally, the table displays which HIHs accept various types of electronic medical documentation transactions for delivery to and from Review Contractors. Currently, the esMD system delivers the following types of documentation in either Portable Document Format (PDF) or Extensible Markup Language (XML) format.

  • Prior Authorization (PA) requests and review results for Power Mobility Devices (PMD)
  • Prior Authorization requests for Repetitive Scheduled Non-Emergent Ambulance Transport
  • First level appeal requests
  • Recovery Auditor discussion requests
  • Advanced Determination of Medical Coverage (ADMC) requests 

Which HIHs have been certified by CMS to offer esMD gateway services to providers?

HIH Name Sends PMD PA Requests in PDF to Review Contractor Receives PMD PA Review Results Messages in XML from Review Contractor Sends Ambulance PA Requests in PDF to Review Contractor  Sends First Level Appeal Requests in PDF to Review Contractor Sends Recovery Auditor Discussion Requests in PDF to Review Contractor Sends ADMC Requests in PDF to Review Contractor
ApeniMed / IOD Yes  Yes No No No No
Bluemark, LLC No No No No No No
Cobius No No No Yes Yes No
Craneware, Inc. No No No No No No
Dorado Systems No No No No No No
Episode   Alert No No No No No No
eSolutions, Inc. Yes Yes Yes Yes Yes Yes
Health IT  Plus Yes Yes No No No No
HealthPort No  No No No No No
IOD Incorporated No No No No No No
IVANS / ABILITY Network Yes Yes No No No Yes
LOISS, Ltd.  No No No Yes Yes No
Medical Electronic Attachment (MEA) Yes  Yes No Yes Yes Yes
MedFORCE Technologies Yes Yes No Yes No No
Medical Records,  LLC No No No No No No
MRO Yes Yes No No No No
Proficient Health No No No No No No
RISARC Yes Yes No No No No
Rycan Technologies, Inc. No No No No No No
SSI No No No Yes No No
SunCoast RHIO, Inc. No No No Yes No No
Verisk Health (formerly MediConnect) No No No No No No
Verisma Systems, Inc. No No No No No No
HIH Name Sends PMD PA Requests in PDF to Review Contractor Receives PMD PA Review Results Messages in XML from Review Contractor Sends Ambulance PA Requests in PDF to Review Contractor Sends First Level Appeal Requests in PDF to Review Contractor Sends Recovery Auditor Discussion Requests in PDF to Review Contractor Sends ADMC Requests in PDF to Review Contractor

Key:    

Yes = Service offered by HIH

No = Service not offered by HIH at this time

The following HIHs have entered into a partnering agreement with a certified esMD HIH, and have started to market esMD gateway services to providers with their own brand name:

  • CM Information Specialists / HealthPort
  • ECC Technologies RAPID Network
  • Fastrack Healthcare Systems
  • Medi-Copy Services, Inc.
  • ScanSTAT Technologies
  • The Wellington Group, LLC
  • Wolters Kluwer Law & Business
  • Compliance 360, an SAI Global Company

Can other HIHs offer esMD gateway services to providers?

Any HIH that meets the following criteria can participate in the esMD program:

  1. The HIH has a contract with one or more Medicare providers to handle their health information.
  2. One or more of the HIH's providers have received a medical documentation request from a Medicare Recovery Auditor or Medicare Administrative Contractor (MAC).
  3. The HIH has built or is building a CONNECT-compatible gateway.
  4. The HIH is willing to obtain an identity certificate and communicate that certificate key to the CMS esMD gateway contractor and the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology (ONC) contractor.

For information on how to become a CMS-certified esMD HIH, visit the esMD "Information for Prospective HIHs" page.

Does CMS pay certified esMD HIHs?

No.

Does CMS contract with certified esMD HIHs?

No.