esMD 4.0 released
As of June 22, 2015, esMD Release 4.0 was successfully deployed into the CMS esMD Production Environment with continued and enhanced functionality including,
- Support sending responses (including review decisions) to Ambulance and HBO Prior Authorization requests
- Support for ASC X12 profile with Prior Authorization requests/responses using ASC X12N 278
- Enhanced 'RC Client' for the Review Contractors (RCs) to easily communicate with esMD
The implementation guides for the Health Information Handlers (HIHs) and Review Contractors have been updated and posted on the 'Information for HIHs' and 'Information for Review Contractors' web pages respectively.
Note: Any HIH ready to accept/send prior authorization request/response using ASC X12N 278 will have to successfully complete the defined esMD on-boarding process (specific to X12 services).
New Functionality Added to esMD
As of July 14, 2014, Release 3.0 was successfully deployed into the CMS esMD Production Environment. The new functionality allows:
- Part A and Part B Medicare Administrative Contractors (A/B MACs) and the Durable Medical Equipment Medicare Administrative Contractors (DME MACs) to voluntarily accept first level appeal requests
- DME MACs to accept Advanced Determination of Medical Coverage (ADMC) on a voluntary basis
- Recovery Auditors to accept discussion requests through the esMD Gateway in Portable Document Format format
- A/B MACs JL and J11 to accept Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization requests
For a complete listing of contractors accepting the above requests, visit the esMD "Which Review Contractors Accept esMD Transactions?" page.
Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport
Parts A and B Medicare Administrative Contractors, Jurisdiction 11 (Palmetto GBA) and Jurisdiction L (Novitas Solutions), are participating in the Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport model.
On December 1, 2014, ambulance suppliers or beneficiaries in Jurisdiction 11 (South Carolina) and Jurisdiction L (New Jersey and Pennsylvania) may begin submitting prior authorization requests for transports occurring on or after December 15, 2014.
To view the Ambulance Prior Authorization Operational Guide, visit the esMD "Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport" page.
esMD Timeline of Completed Activities
- July 2014: Release 3.0 was successfully deployed into the CMS esMD Production Environment
- July 2014: DME MACs for Jurisdictions A and D began accepting first level appeals through esMD
- July 2014: A/B MACs for Jurisdictions F, 10, and 11 began accepting first level appeals through esMD
- July 2014: Recovery Auditors began accepting Recovery Auditor Discussion Requests through esMD
- June 2014: ZPIC for Zone 5 began accepting medical documentation responses through esMD
- June 2014: ZPIC for Zone 2 began accepting medical documentation responses through esMD
- October 2014: U.S. Railroad Retirement Board (RRB) began accepting medical documentation responses and first level appeals through esMD
- December 2014: CMS expanded the Prior Authorization program to include the Repetitive Scheduled Non-Emergent Ambulance Transport model
- December 2014: A/B MAC JL (Novitas Solutions) began accepting Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization Requests through esMD
- December 2014: A/B MAC J11 (Palmetto GBA) began accepting Repetitive Scheduled Non-Emergent Ambulance Transport Prior Authorization Requests through esMD
esMD Timeline of Future Activities
CMS plans to implement the following esMD activities:
- Fiscal Year 2015: CMS is planning to expand the Prior Authorization program to include Hyperbaric Oxygen therapy
Latest Data Use and Reciprocal Service Agreement (DURSA) Update
As of September 15, 2012, CMS no longer requires Health Information Handlers (HIHs) to sign an attestation obligating them to a DURSA. The DURSA form was a part of the CMS on-boarding process and esMD certification.
Follow us at #CMS_esMD for esMD specific news and information.
CMS esMD Team E-mail Addresses:
To serve your esMD needs promptly, CMS has two relevant esMD email addresses. Please use the following email addresses to direct esMD questions to the applicable component.
for general information and technical support questions Contact:
esMD Help Desk
esMD Business Owners
for business support questions
- To see a 5 minute video overview of esMD, click on the link titled "Melanie Introduces Provider to esMD Video" in the 'Related Links' section below.
- To view a list of which HIHs offer this service, click the link titled "HIHs that offer Prior Auth submission services" in the 'Related Links' section below.
- To find information on the Prior Authorization Demonstrations, click the Prior Authorization links in the 'Related Links' section below.