Electronic Submission of Medical Documentation (esMD)

The Medicare Fee-for-Service (FFS) Compliance programs prevent, reduce, and measure improper payments through medical review. We provide a number of programs to educate and support Medicare providers in understanding and applying Medicare FFS policies while reducing provider burden.

The Electronic Submission of Medical Documentation (esMD) system helps different entities eliminate the need to mail or fax paper documents. esMD allows:

  • Providers and suppliers to electronically submit medical documentation requested by the Centers for Medicare and Medicaid Services (CMS) for improper payment review and requests for prior authorization.
  • Review contractors (RCs) to submit Additional Document Requests (ADRs) to providers electronically.
  • RCs to exchange solicited documents with other CMS adjudicators electronically.

esMD reduces burden on providers and supports CMS’ broader eHealth Initiative.

Get Started with esMD

 

Providers can use esMD to submit documentation for the following Lines of Business (LOBs):

  • Prior Authorization Requests for Hospital Outpatient Department (OPD)
  • Prior Authorization (PA) Requests for Repetitive Scheduled Non-Emergent Ambulance Transport
  • Home Health Pre-Claim Review Requests
  • Response to Additional Document Requests (ADR)
  • Supporting Documentation for PA Request
  • Paperwork (PWK) Unsolicited documents
  • First and Second Level Appeal Requests
  • Advanced Determination of Medicare Coverage Requests (ADMC)
  • Durable Medical Equipment (DME) Phone Discussion Requests

Suppliers can use esMD to submit documentation for the following LOBs:

RCs can use esMD to request information for the following LOBs:

  • Requested documents to other CMS adjudicators
  • Pre-Pay and Post-Pay Electronic Medical Documentation Request (eMDR) letters

Refer to Introducing esMD to New Providers RCs and HIHs (PDF) for benefits and other details.

Current Release Documents

The esMD technical team distributes the following documents for RCs and Health Information Handlers (HIHs) during the course of the release:

  • Release Summary Document
  • The RC/HIH Initial Technical Release Change Document
  • The RC/HIH Final Technical Release Change Document

Visit esMD for Health Information Handlers and esMD For Review Contractors for the most current versions of these documents.

Future Functionalities

esMD is planning to support XDR and X12 278 transaction formats for Hospital Outpatient PA requests and responses during the July/October 2020 releases. All HIHs and RCs should review the information provided in the respective esMD release documents.

Page Last Modified:
08/03/2020 07:51 AM