Electronic Submission of Medical Documentation (esMD) January 11, :00 PM – 3:00 PM Community Meeting 0

Today’s Agenda 1 TopicPresenterTime 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 DiagramsB. Dieterle2:10-2:25 Review of Updates to User Story 1, Assumptions, Actors and Roles, Pre and Post conditions P. Patel2:25-2:45 Introduction of the Activity Diagram and associated base flow P. Patel2:45-3:00

QUICK REVIEW OF ELECTRONIC SERVICE INFORMATION (ESI) 2

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, ) Digital Certificate Information Personal ESI Relationship Information Organization-Organization Relationships Individual-Organization Relationships Relationship specific contact information (telephone, ) Relationship specific certificate Relationship specific ESI Individual Information Relationship Information Organization Information 3 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, ) 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: Preferred: 2 4 Example 2 – NwHIN ESI ID: 550e8400-e29b-41d4-a Integration Profile: PatientDiscovery:2.0 Address: Preferred: 1 Example 3 – X12 (Core X12 270/271) ESI ID: eb f54-4ef8-a4d0-bb658a1fc6cf Integration Profile: CAQH CORE Connectivity Rule Content Profile: X12N 270/271 Content Profile Version: X279 X279A1 Address: Preferred: 1

REVIEW OF UPDATED CONTEXT DIAGRAMS 5

PPA Use Case Context Diagram – Information Exchange Paths – General Case 6 Payer Organization Payer Organization Provider / Provider Organization Contractors / Intermediaries Agent / Access Access Gateway Provider Information Directories

PPA Use Case Context Diagram – CMS Provider Registration 7 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

PPA Use Case Context Diagram – CMS Secure MDR transmission from Contractors 8 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.

PPA Use Case Context Diagram – Commercial Payer Provider Registration 9 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 – Secure eMDR transmission from Commercial Payer via Contractor 10 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 11 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.