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Which HIHs Offer esMD Gateway Services to Providers?

What is a Health Information Handler?

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 esMD system allows providers and HIHs to electronically send their responses to Additional Documentation Request (ADR) letters to review contractors during the claims review process. As the Centers for Medicare & Medicaid Services (CMS) enhances esMD functionality, HIHs may elect to participate in specific services offered on the expanded esMD menu. The following table displays the HIHs that are currently certified by CMS to offer the various types of esMD transaction services. Currently, the esMD system delivers the following types of electronic medical 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 Health Information Handlers (HIHs) have been certified by CMS to offer esMD gateway services to providers

  • Bluemark, LLC
  • Cobius
  • Craneware, Inc
  • eSolutions, Inc.
  • First Genesis
  • HealthPort
  • IOD Incorporated
  • IVANS / ABILITY Network
  • LOISS, Ltd.
  • Medical Electronic Attachment (MEA)
  • MedFORCE Technologies
  • MRO  
  • RISARC
  • Rycan Technologies, Inc.
  • SSI
  • SunCoast RHIO, Inc.
  • Verisma Systems, Inc.

To view the esMD services that each of the CMS certified HIHs offer, click on the document titled "CMS certified Health Information Handlers Services" located in the 'Downloads' section at the bottom of this web page.

To view the HIHs list that 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, click on the document titled "HIHs partnered with certified esMD HIHs list" located in the 'Downloads' section at the bottom of this web page.

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.

Does CMS pay certified esMD HIHs?

No.

Does CMS contract with certified esMD HIHs?

No.