Information for HIHs
For information on becoming an Electronic Submission of Medical Documentation (esMD) Health Information Handler (HIH), review the presentation "Introducing esMD to Providers, RCs, and HIHs" in the "Downloads' section.
The HIH Onboarding Process gives HIHs 23 weeks to set up and complete their validation and production environments. We recommend that HIHs ensure they have an experienced technical staff to expedite all testing tasks. HIHs should refer to the "esMD HIH Implementation Guide" and the "esMD Onboarding steps" in the 'Downloads' section to assess the requirements. We have found that having knowledge of CONNECT software and the Simple Object Access Process (SOAP) User Interface (UI) tool is helpful.
Interested HIHs should complete and submit the "esMD HIH Onboarding Request Form" in the 'Downloads' section.
The "esMD HIH Change Request - Certificate Renewal Form", in the 'Downloads' section, is for certified HIHs requesting changes.
Frequently Asked Questions
What is the correct claim identifier (ID) format and how should it be submitted ?
The Claim ID is the identifier with which the provider submits the claim to the Centers for Medicare & Medicaid Services (CMS). It can be found in the Additional Documentation Request (ADR) letter from the Review Contractor and needs to be used to submit:
- Documents in response to ADR from the CMS Review Contractor(s)
- Recovery Auditor discussion requests
- Advanced Determination of Medicare Coverage (ADMC) requests
The esMD Claim ID value for documents submitted in responses to ADR, Recovery Auditor discussion requests, and ADMC requests need to have one of the following character lengths or the submission will be rejected:
- 13 numeric characters in length
- 14 numeric characters in length
- 15 numeric characters in length
- 17 – 23 variable (can include alphabets, numbers, dashes and spaces) characters in length
From esMD R3.0 onwards, HIHs and providers should submit the ADR, Recovery Auditor discussion requests, and ADMC requests with the esMD Claim ID in either of the following two formats (to enable backward compatibility). However, it is recommended for the HIH to submit the esMD Claim ID in the Standard Format.
- The HL7 CX composite format contains two components: (1) the esMD Claim ID number and (2) the Assigning Authority (AA) (i.e., the CMS Review Contractor, which identifies the domain over which the esMD Claim ID number represents a unique entity).
- The composite format looks like this: Claim ID^^^&RC OID&ISO
- The ‘&’ character must be properly (like &) encoded in the XML content.
- If there are any errors in the composite format, or in the format/length of the esMD Claim ID, the submission will be rejected.
- In the example below the esMD Claim ID value is 13 numeric characters:
- Example: <urn4:Slot name="esMDClaimId"> <urn4:ValueList> <urn4:Value>1234567890123^^^&2.16.840.1.1138184.108.40.206.1.100.1&ISO</urn4:Value> </urn4:ValueList> </urn4:Slot>
- Alternatively, HIHs can send just the esMD Claim ID alone, as displayed in the example below.
- If there are any errors in the format/length of the esMD Claim ID, the submission will be rejected.
- Example: <urn4:Slot name="esMDClaimId"> <urn4:ValueList> <urn4:Value>1234567890123</urn4:Value> </urn4:ValueList> </urn4:Slot>
Power Mobility Device (PMD), Non-Emergent Ambulance Transport, and Hyperbaric Oxygen (HBO) Prior Authorization (PA) requests:
- Documentation submissions sent in reference to the aforementioned lines of business shall not have an esMD Claim ID.
- HIHs are advised to send PA request submissions relating to PMD, Non-Emergent Ambulance Transport, and HBO without the XML tag for the esMD Claim ID field.
- If HIHs send a value for the esMD Claim ID attribute, the submission will be rejected.
Where can I obtain CONNECT Software and how much does it cost?
The Centers for Medicare & Medicaid Services (CMS) esMD gateway was built with the use of the CONNECT software. The CONNECT gateway software is open-source (free) and available at www.connectopensource.org.
Are HIHs required to use CONNECT software?
HIHs are not required to use CONNECT software. However, their gateway must be CONNECT-compatible to ensure that it will be able to exchange information with the CMS esMD gateway.
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.
Does CMS plan to "freeze" the code and utilize CONNECT throughout the life of the esMD pilot project? Will CMS update its Gateway every time a new version of CONNECT is released?
CMS plans to update its CONNECT gateway software code each time a new CONNECT feature is released that CMS determines would be beneficial to the esMD program.
Where can I find the "esMD HIH Implementation Guide" and related codes?
Please check the website periodically for the latest version of the "esMD HIH Implementation Guide" and related codes in the 'Downloads' section below.
How do I electronically send or receive Additional Documentation Letters (ADR)?
The Electronic Submission of Medical Documentation (esMD) system allows:
- Providers and Health Information Handlers (HIHs) to electronically send their responses to ADR letters to review contractors during the claims review process
- Review contractors to electronically receive responses to ADR letters sent by providers and HIHs during the claims review process
For more information on the benefits of esMD and how to join, please view the PowerPoint titled “Introducing esMD to Providers, RCs, and HIHs 2015” in the 'Downloads' section below. Furthermore, view the Program Integrity Manual section 220.127.116.11 – “Additional Documentation Request Required and Optional Elements” in addition to the associated Program Integrity Manual Exhibits 46.1 – 46.5. Also, view the esMD web pages listed on the navigation menu on the upper left hand side of this page.
- HIH Implementation Guide for AR2018.07.0 [PDF, 2MB]
- esMD HIH Infrastructure Change Request Certificate Renewal Form [PDF, 292KB]
- esMD HIH Onboarding Request Form 06302016 [PDF, 4MB]
- ADRReviewResultsPilot_ReasonCodesAndStatements_1 26 17 [PDF, 329KB]
- Home Health Services_PCR_ReasonCodesAndStatements_120916 [PDF, 371KB]
- Introducing esMD to Providers, RCs, and HIHs 2015 [PPTX, 3MB]
- NonEmergentAmbulanceReasonCodesAndStatements [PDF, 311KB]
- Prior Authorization Industry Codes - XML (04/06/2015) [PDF, 240KB]
- Prior Authorization Reject Codes - XML (04/06/2015) [PDF, 317KB]
- NonEmergentHBO_ReasonCodesAndStatements_7.3.17 [PDF, 258KB]
- PMD_ReasonStatementsAndIdentifiers_090617 [PDF, 292KB]
- RC_OID_Table_042018_Updated [PDF, 276KB]
- esMD Onboarding Steps for HIH [PDF, 422KB]
- esMD_X12_275_Companion_Guide_AR2017.10.0 [PDF, 813KB]
- esMD_X12_278_Companion_Guide_AR2017.10.0 [PDF, 1MB]
- esMD_X12_278_Companion_Guide_AR2017.01.0_Errata [PDF, 96KB]
- esMD HIH Agreement [PDF, 192KB]
- esMD HIH Agreement Instructions [PDF, 207KB]
- RC POC for HIH Use [PDF, 223KB]
- Page last Modified: 04/20/2018 12:11 PM
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