Electronic Submission of Medical Documentation (esMD) Pilot Project

The Centers for Medicare & Medicaid Services (CMS) has developed a new mechanism for contractors to receive medical documentation electronically from providers and suppliers, in response to an Additional Documentation Request (ADR).  This new mechanism is identified as Electronic Submission of Medical Documentation (esMD). The CMS is currently in the process of piloting the esMD project with various contractors who review medical documentation (i.e., Recovery Audit Contractors (RACs), Medicare Administrative Contractors (MACs), Comprehensive Error Rate Testing (CERT) Contractor, etc.).

 

This pilot project includes two phases. The first phase went live on September 15, 2011, with the release of change request (CR) 7254 which provided instructions for MACs to implement a process for receiving electronic documentation and to update ADRs with a newly created Case ID number.  National Government Services, the Jurisdiction B Durable Medical Equipment Medicare Administrative Contractor (DME MAC) began accepting documentation electronically on September 22, 2011.   

 

The next step in phase one is the system implementation phase of the project and is scheduled for January 3, 2012. Based on Medicare Learning Network (MLN) Matters article 7254 Medicare systems will update ADR letters to include how to obtain additional information for esMD and create an additional field called a Case ID number. The Case ID number will be composed of twenty three characters. The first five characters will be the contractor ID numbers followed by the claim ID number, and then remaining will be enough zero’s to create a twenty three digit ID number. Two alpha characters at the end of the documentation Case ID will describe the specific type of review, PR (prepay), PO (postpay) or MA (manual development).

 

The second phase of the esMD pilot project will allow providers to receive ADR request of a claim electronically from the contractors, in addition to other project enhancements. Phase 2 is scheduled to go live in October 2012.

 

Please note that participation of the esMD project is not mandatory. Additional information about esMD project can be found on the CMS esMD link located at: http://www.cms.gov/esmd/.

 

Suppliers responding to the ADR request electronically should continue to submit the ADR letter with their documentation.  The ADR letter allows the contractors to identify the claim in which the supplier is responding to, as well as help track the submitted documentation through the new Case ID number.

 

For additional information regarding the esMD pilot project, suppliers should refer to the following located on the CMS Web site at:

 

CMS Web page

http://www.cms.gov/ESMD/03_Review-Contractors.asp

 

SE1110

http://www.cms.gov/MLNMattersArticles/Downloads/SE1110.pdf

 

MM7254

http://docushare.corp.ngsmedicare.com/docushare/dsweb/Get/Document-946335/Revised%20MM7254.pdf