esMD for Medicare Providers and Suppliers
esMD for Medicare Providers and Suppliers
By eliminating the need to mail or fax paper documents, the Electronic Submission of Medical Documentation (esMD) system reduces burden on providers and supports the Centers for Medicare and Medicaid Services’ (CMS) broader eHealth Initiative.
Providers and suppliers can use esMD to submit supporting medical documentation for the Lines of Business mentioned on the esMD Overview page.
Any provider or supplier who wants to use esMD to electronically submit supporting medical documentation to a CMS review contractor (RC) must either:
- Build a gateway of their own (and sign up as a Health Information Handler with esMD) or
Work with a Health Information Handler (HIH) with existing Gateway services.
HIHs are organizations that provide the necessary software and communication services to securely exchange medical documentations between providers and RCs.
Contact the esMD Help Desk for additional assistance.
Frequently Asked Questions
Which HIHs and RCs participate in esMD services?
Health Information Handlers
- Inovalon (formerly ABILITY Network)
- Bluemark, LLC
- MRO
- CIOX Health
- SSI
- Cobius
- SunCoast RHIO Inc.
- Synergy Health Services (formerly Consulate Healthcare)
- UPMC
- Craneware, Inc.
- Vyne Medical
- Waystar (formerly eSolutions, Inc.)
- CMS HIH
- Digital HIE
- HFMI, LLC (X12 only)
Review Contractors
DME MACs
- DME MAC JA & JD (Noridian)
- DME MAC JB & JC (CGS)
MACs
- MAC JE & JF (Noridian)
- MAC J6 & JK (NGS)
- MAC JJ & JM (Palmetto)
- MAC JH & JL (Novitas Solutions)
- MAC J15 (CGS)
- MAC JN (First Cost Service Options)
- MAC J5 & J8 (WPS)
RACs
- Performant (RAC Region 1, 2 & 5)
- Cotiviti (RAC Region 3 & 4)
UPICs
- UPIC West & South West (Qlarant) UPIC
- UPIC Mid-West (Covent Bridge, formerly AdvanceMed)
- North East & South East (Safeguard Services)
SMRC
- Noridian
RRB
- Palmetto
CERT
- Empower AI (formerly NCI Inc.)
PERM
- Empower AI (formerly NCI Inc.)
QICs
- QIC Part A West & DME (Maximus)
- QICs Part A East, Part B North & South (C2C)
QIOs
- QIO Appeals (Livanta)
- QIO Quality of Care Complaints (Livanta)
- QIO HWDRG (Livanta)
- QIO SSR (Livanta)
Will providers get more Recovery Auditor medical documentation requests if they respond quickly? For example, if a provider submits requested documentation in 20 days, will this cause the Recovery Auditor to “restart the clock” earlier for the next round of medical documentation requests?
No. The CMS allows Recovery Auditors to issue documentation requests every 45 days. This equates to 8 times a year. When medical documentation is received by the Recovery Auditor, this does not change the 45 day period for when Recovery Auditor could issue the next documentation request. The purpose of the 45 days is so that providers do not have several open documentation requests at one time. (esMD does NOT track and/or monitor the turnaround time between the request and the response.)
Are providers required to electronically submit medical documentation?
Participation in esMD is voluntary. Providers who are content with faxing or mailing documentation to their RCs may continue to do so. However, providers who believe it would be more efficient to respond to documentation requests electronically are encouraged to contact one or more of the HIHs to determine if esMD services are available to the provider for a reasonable price.
Which type of Electronic Health Record must I have to use esMD?
The esMD allows for the submission of Portable Document Format (PDF) files. Therefore, any Electronic Health Record system that is capable of exporting health information as a PDF file can be submitted via an esMD gateway.
Are providers still using paper records excluded from using esMD?
Providers who have paper records can use esMD services so long as they have a mechanism to scan the paper records into a PDF file. Some esMD HIHs specialize in this kind of service.
Will providers who use esMD be more likely to get selected for review?
No. CMS prohibits review contractors from selecting providers based on their esMD status (CMS Program Integrity Manual, Chapter 3, Section 3.2.1 (PDF)).
What date will the review contractors use as a receipt date for esMD submissions?
Medicare Administrative Contractors (MACs) uses the esMD Enterprise File Transfer (EFT) system receipt date as the date the documentation was received. For more information on the receipt date refer to the Process for Handling Electronic Submission of Medical Documentation (esMD) Transmittal (PDF).
Where can I find a list of reasons for denied/non-affirmed decisions?
Check the website periodically for the latest version of the Review Reason Codes and Statements.
What is Medicare Fee-for-Service program?
Please refer to the link Medicare Fee-for-Service Compliance Programs.
Page Last Modified:
11/08/2024 09:48 AM