Information for Review Contractors
The Electronic Submission of Medical Documentation (esMD) system provides a mechanism for exchanging medical documentation (and responses) between the Medicare Provider community and the Medicare Review Contractor (RC) community. The purpose is to enable the electronic transmission of information between Health Information Handlers (HIHs) who represent Providers and the Medicare RCs, replacing paper documents where possible. The RCs request medical documentation by sending a letter to the provider. In the past, medical documentation providers had only two options for delivering the medical documentation requested by sending it by letter or fax. The esMD system gives providers the option of sending medical documentation electronically to a requesting RC, instead of sending the documentation by letter or fax.
Many providers use an HIH organization to perform tasks, such as submitting claims and providing electronic health record systems. Any organization that handles health information on behalf of a provider is an HIH. Some HIHs are beginning to offer esMD gateway services, often referred to as Claim Clearinghouses, Release of Information vendors, Health Information Exchanges, and Electronic Health Record vendors. The esMD system allows providers, HIHs, and gateway services to send responses for requests for additional documentation electronically to a RC during the claims review process.
For information on becoming an esMD Review Contractor, review the presentation "Introducing esMD to Providers, RCs, and HIHs" in the "Downloads' section.
Review contractors should refer to the RC Client (Java and .NET) Implementation Guides in the 'Downloads' section to assess the requirements.
Interested RCs should complete and submit the "esMD RC Onboarding Request Form" in the 'Downloads' section.
Frequently Asked Questions
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.
What is the email address for the esMD Help Desk
Where can I find the esMD RC Implementation Guides and related codes?
Please check the website periodically for the latest versions of the esMD RC Implementation Guides (Java and .NET) and related codes in the 'Downloads' section below.
- RC Implementation Guide .NET for AR2018.07.0 [PDF, 4MB]
- RC Implementation Guide Java for AR2018.07.0 [PDF, 4MB]
- EIDM Instructions [DOCX, 3MB]
- esMD RC Onboarding Form [PDF, 284KB]
- Introducing esMD to Providers, RCs, and HIHs 2015 [PPTX, 3MB]
- ADRReviewResultsPilot_ReasonCodesAndStatements_1 26 17 [PDF, 329KB]
- PMD_ReasonStatementsAndIdentifiers_090617 [PDF, 292KB]
- Home Health Services_PCR_ReasonCodesAndStatements_120916 [PDF, 371KB]
- NonEmergentHBO_ReasonCodesAndStatements_7.3.17 [PDF, 258KB]
- NonEmergentAmbulanceReasonCodesAndStatements [PDF, 311KB]
- Error Codes From esMD to RCs (04/06/2015) [PDF, 251KB]
- Prior Authorization Industry Codes - XML (04/06/2015) [PDF, 240KB]
- Prior Authorization Reject Codes - XML (04/06/2015) [PDF, 317KB]
- esMD_X12_275_Companion_Guide_AR2017.10.0 [PDF, 813KB]
- esMD_X12_278_Companion_Guide_AR2017.10.0 [PDF, 1MB]
- RC_OID_Table_042018_Updated [PDF, 276KB]
- HIH POC for RC Use [PDF, 229KB]
- Page last Modified: 04/20/2018 12:11 PM
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