Electronic Submission of Medical Documentation (esMD)
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Electronic Submission of Medical Documentation (esMD) January 11, 2012 2:00 PM – 3:00 PM Community Meeting 1
description
Electronic Submission of Medical Documentation (esMD). Community Meeting. Today’s Agenda. Quick Review of electronic service information ( esi ). Query for Electronic Service Information – Data Set Overview – Response Detail. Provider Directory Information PD identifier and name. - PowerPoint PPT Presentation
Transcript of Electronic Submission of Medical Documentation (esMD)
Electronic Submission of Medical Documentation (esMD)
January 11, 20122:00 PM – 3:00 PM
Community Meeting
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Today’s Agenda
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Topic Presenter Time Allotted
Follow up from last meeting-Review of ESI-Relevance of Registration for all payers
P. Patel B. Dieterle
2:00-2:10
Review of Updated Context Diagrams B. Dieterle 2:10-2:25
Review of Updates to User Story 1, Assumptions, Actors and Roles, Pre and Post conditions
P. Patel 2:25-2:45
Introduction of the Activity Diagram and associated base flow
P. Patel 2:45-3:00
QUICK REVIEW OF ELECTRONIC SERVICE INFORMATION (ESI)
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Query for Electronic Service Information – Data Set Overview – Response Detail
Individual Information• Unique Identifier(s) and Status• Name and alias(es)• Address(es)• Gender and DOB• Type• NPI• Degree(s)• License(s)• Certification(s)• Specialty(ies)• Contact Information (telephone, email)• Digital Certificate Information• Personal ESI
Relationship Information• Organization-Organization Relationships• Individual-Organization Relationships
• Relationship specific contact information (telephone, email)
• Relationship specific certificate• Relationship specific ESI
Individual Information
Relationship Information
Organization Information
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Provider Directory Information• PD identifier and name
Organization Information• Unique Identifier(s) and Status• Name and alias(es)• Address(es)• NPI(s)• Type(s)• Certification(s)• Specialty(ies)• Contact Information (telephone, email)• Organizational Policy Information• Digital Certificate Information• Organization ESI
Query for Electronic Service Information – Data Set Overview – ESI detail • Unique ESI identifier (required)• Integration Profile Information
• Integration Profile (required)• Integration Profile Version• Integration Profile Options
• Content Profile Information• Content profile • Content profile version• Content profile constraints
• Security Profile Information• Security profile• Security profile version• Security profile options
• Address (Electronic) of Service (required)• Preferred Method (required)
Example 1 – Direct (CCD C32 payload)• ESI ID: f81d4fae-7dec-11d0-a765-00a0c91e6bf6• Integration Profile: DirectProjectSMTP• Content Profile: HITSP C32• Content Profile Version: 2.5• Address: https://[email protected] • Preferred: 2
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Example 2 – NwHIN • ESI ID: 550e8400-e29b-41d4-a716-446655440000• Integration Profile: PatientDiscovery:2.0• Address: https://health.org/PatientDiscovery.wsdl• Preferred: 1
Example 3 – X12 (Core X12 270/271)• ESI ID: eb424026-6f54-4ef8-a4d0-bb658a1fc6cf• Integration Profile: CAQH CORE Connectivity Rule• Content Profile: X12N 270/271• Content Profile Version: 005010 X279 X279A1• Address: https://health.org/Core5010x279.wsdl• Preferred: 1
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REVIEW OF UPDATED CONTEXT DIAGRAMS
PPA Use Case Context Diagram – Information Exchange Paths – General Case
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PayerOrganization
Provider / Provider
Organization
Contractors / Intermediaries
Agent / Access
Access
Gate
way
Provider Information Directories
PPA Use Case Context Diagram – CMSProvider Registration
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CMSProvider / Provider
Organization
Contractors / Intermediaries
HIH
ConnectesM
D Ga
tew
ay
CMS PD
1. HIH/Provider Sends electronic registration request to CMS
2. CMS sends ESI query to PD to determine
capability of provider / HIH to receive medical
documentation request (eMDR).
3. ESI query response sent to CMS
4. Confirmation of registration sent from CMS
In to CMS
Out from CMS
Provider Information Directories
Key : ESI – Electronic Services Information
PPA Use Case Context Diagram – CMSSecure MDR transmission from Contractors
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CMSProvider / Provider
Organization
Contractors / Intermediaries
Provider Information Directories
HIH
ConnectesM
D Ga
tew
ay
In to ContractorOut from Contractor
5. Electronic medical documentation request (MDR) sent securely to Provider or HIH as needed *
1. Sends request for provider registration status
4. Receives updated ESI
Information
2. Receives validation of registration status
3. Sends request to retrieve
updated ESI informationOut to Provider
CMS PD
Key : ESI – Electronic Services Information* Electronic MDR is sent only when CMS identifies the need for documentation.
PPA Use Case Context Diagram – Commercial Payer Provider Registration
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Commercial Payer Provider /
Provider Organization
Contractors / Intermediaries
Agent
Connect
Gate
way
Payer PD
1. HIH/Provider Sends electronic registration request to Payer
2. Payer sends ESI query to PD to determine
capability of provider / Agent to receive medical
documentation request (eMDR).
3. ESI query response sent to Payer
4. Confirmation of registration status sent from Payer
In to Payer
Out from Payer
Provider Information Directories
Key : ESI – Electronic Services Information
Use Case 2 – (We will cover this once we start UC 2)PPA Use Case Context Diagram – Secure eMDR transmission from Commercial Payer via Contractor
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Commercial Payer Provider /
Provider Organization
Contractors / Intermediaries
Provider Information Directories
Agent
Connect
Gate
way
In to ContractorOut from Contractor
5. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed *
1. Sends request for provider registration status
4. Receives updated ESI
Information
2. Receives validation of registration status
3. Sends request to retrieve
updated ESI informationOut to Provider
Payer PD
Key : ESI – Electronic Services Information* eMDR is sent only when Payer identifies the need for documentation.
Use Case 2 – (We will cover this once we start UC 2)PPA Use Case Context Diagram – Secure eMDR transmission from Commercial Payer
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Commercial Payer
Provider / Provider
Organization
Contractors / Intermediaries
Provider Information Directories
Agent
Connect
Gate
way
3. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed *
2. Receives updated ESI
Information
1. Sends request to retrieve
updated ESI informationOut to Provider
Payer PD
Key : ESI – Electronic Services Information* eMDR is sent only when CMS identifies the need for documentation.
