By eliminating the need to mail or fax paper documents, the Electronic Submission of Medical Documentation (esMD) system reduces burden on providers and supports the Centers for Medicare and Medicaid Services’ (CMS) broader eHealth Initiative.
Providers and suppliers can use esMD to submit supporting medical documentation for the Lines of Business mentioned on the esMD Overview page.
Any provider or supplier who wants to use esMD to electronically submit supporting medical documentation to a CMS review contractor (RC) must either:
Contact the esMD Help Desk for additional assistance.
Frequently Asked Questions
Which HIHs and RCs participate in esMD services?
Health Information Handlers
- ABILITY Network/IVANS
- LOISS, Ltd.
- Bluemark, LLC
- MedFORCE Technologies
- CIOX Health
- SunCoast RHIO Inc.
- Consulate Healthcare
- Craneware, Inc.
- Vyne Medical
- Waystar (formerly eSolutions, Inc.)
- DME MAC JA & JD (Noridian)
- DME MAC JB & JC (CGS)
- MAC JE & JF (Noridian)
- MAC J6 & JK (NGS)
- MAC JJ & JM (Palmetto)
- MAC JH & JL (Novitas Solutions)
- MAC J15 (CGS)
- MAC JN (First Cost Service Options)
- MAC J5 & J8 (WPS)
- Performant (RAC Region 1 & 5)
- Cotiviti (RAC Region 2, 3 & 4)
- UPIC West & South West (Qlarant) UPIC
- UPIC Mid-West (Covent Bridge, formerly AdvanceMed)
- North East & South East (Safeguard Services)
- NCI Inc. (formerly AdvanceMed)
- NCI Inc. (formerly AdvanceMed)
- QIC Part A West & DME (Maximus)
- QICs Part A East, Part B North & South (C2C)
- QIO Appeals (Livanta)
- QIO Quality of Care Complaints (Livanta)
- QIO HWDRG (Livanta)
- QIO SSR (Livanta)
Will providers get more Recovery Auditor medical documentation requests if they respond quickly? For example, if a provider submits requested documentation in 20 days, will this cause the Recovery Auditor to “restart the clock” earlier for the next round of medical documentation requests?
No. The CMS allows Recovery Auditors to issue documentation requests every 45 days. This equates to 8 times a year. When medical documentation is received by the Recovery Auditor, this does not change the 45 day period for when Recovery Auditor could issue the next documentation request. The purpose of the 45 days is so that providers do not have several open documentation requests at one time. (esMD does NOT track and/or monitor the turnaround time between the request and the response.)
Are providers required to electronically submit medical documentation?
Participation in esMD is voluntary. Providers who are content with faxing or mailing documentation to their RCs may continue to do so. However, providers who believe it would be more efficient to respond to documentation requests electronically are encouraged to contact one or more of the HIHs to determine if esMD services are available to the provider for a reasonable price.
Which type of Electronic Health Record must I have to use esMD?
The esMD allows for the submission of Portable Document Format (PDF) files. Therefore, any Electronic Health Record system that is capable of exporting health information as a PDF file can be submitted via an esMD gateway.
Are providers still using paper records excluded from using esMD?
Providers who have paper records can use esMD services so long as they have a mechanism to scan the paper records into a PDF file. Some esMD HIHs specialize in this kind of service.