Which Review Contractors Accept esMD Transactions?

Electronic Submission of Medical Documentation (esMD)

The esMD system allows review contractors to electronically receive responses to Additional Documentation Request (ADR) letters sent by providers and Health Information Handlers (HIHs) during the claims review process. As the Centers for Medicare & Medicaid Services (CMS) enhances esMD functionality, review contractors may elect to participate in specific services offered on the expanded esMD menu. The following tables display which review contractors participate in the various types of additional esMD transaction services. Currently, the esMD system delivers the following types of electronic medical documentation in either Portable Document Format 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 

For more information about the PMD and Ambulance Prior Authorization processes, click the links titled "PMD Prior Authorization" and "Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport" in the 'Related Links' section below.

Which Review Contractors offer esMD services?

To view the full lists of CMS Review Contractors and the esMD services they offer, click on the following documents located in the 'Downloads' section at the bottom of this web page.

Page Last Modified:
10/16/2018 02:58 PM