PPA Use Case Context Diagram – Information Exchange Paths – General Case 0 Payer Organization Payer Organization Provider / Provider Organization Contractors / Intermediaries Agent / Access Access Gateway Provider Information Directories

Use Case 1 PPA Use Case Context Diagram – CMS Provider Registration 1 CMS Provider / Provider Organization Contractors / Intermediaries HIH Connect esMD Gateway 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

Use Case 1 PPA Use Case Context Diagram – Commercial Payer Provider Registration 2 Commercial Payer Provider / Provider Organization Contractors / Intermediaries Agent Connect Gateway 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 – CMS Secure MDR transmission from Contractors 3 CMS Provider / Provider Organization Contractors / Intermediaries Provider Information Directories HIH Connect esMD Gateway In to Contractor Out 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 information Out to Provider CMS PD Key : ESI – Electronic Services Information * Electronic MDR is sent only when CMS 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 via Contractor 4 Commercial Payer Provider / Provider Organization Contractors / Intermediaries Provider Information Directories Agent Connect Gateway In to Contractor Out 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 information Out 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 5 Commercial Payer Provider / Provider Organization Contractors / Intermediaries Provider Information Directories Agent Connect Gateway 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 information Out to Provider Payer PD Key : ESI – Electronic Services Information * eMDR is sent only when CMS identifies the need for documentation.