This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Electronic Submission of Medical Documentation (esMD) Technical Overview
MELANIE COMBS-DYER, RN - Deputy Director, CMS/OFM/Provider Compliance Group
DANIEL KALWA - Health Insurance Specialist, CMS/OFM/Provider Compliance Group
System (HIH) to System (CMS) Gateway Communication HIH Submits XDR (Deferred Document Submission) SOAP Envelope Request to CMS
CONNECT gateway with the following details SAML Assertions and its digital signature, Security Tags in the SOAP Header, IHE XDR and esMD Meta Data with in the SOAP Body. MTOM Encoded C62 Payload in the SOAP Body.
SAML Assertions shall contain the HIH Organization Identifier (OID), Review Contractor Organization Identifier (OID), NPI Provider Identification etc.
Authentication HIH IP Address validation Mutual TLS v1.0 certificate validation (later used for encryption and decryption
of request, responses and its digital signatures) Exchange and validate FIPS 140/2 TLS Cipher Suites. Timestamp and SAML Digital Signature validation HIH OID and Intended Review Contractor validation against HIH and CMS
Review Contractor OIDs based on the CMS onboarding Process. Message and payload integrity verification based on the base 64 encoding -
MD5 digest/hashcode algorithms. Authorization
HIH OID and Intended Recipient OID against the esMD CMS on-boarded data. Up to 19MB of PDF Payload size
Using the Health Information Handler (HIH) Gateway, provider submits a claim document response to a single CMS Additional Documentation Request Letter (ADR), using the Document Submission deferred request (as a part of deferred messaging flow).
esMD implements the NHIN Document Submission with Deferred Messaging mode. In a deferred mode, the Document Submission is a two-way message as shown in the diagram below:
So, What's Next? • Future esMD Use Cases• How to accommodate ASC X12 transactions?
o Does CONNECT Support ASC X12 Transactions?o Are there any NHIN profiles to support the ASC X12 Transactions?
• How to allow outbound transactions from CMS esMD Gateway to HIH in compliance with FISMA and other security requirement?
• Identify the Technical requirements to expand the esMD Use Cases.
• Provider Profile/ Provider Naming Service etc
In Sept 2011, esMD successfully implemented the IHE XDR Profile with inbound ADR Use Case.
17
Current and Future Use Casesfor esMD
We Are HereINBOUND Responses to Documentation Request Letters in PDF Appeal Requests in PDF Unsolicited Documentation in PDF (called paperwork or “pwk”) Structured Orders, Progress Notes, ADMC Requests Structured esMD Phase 2 Registration etc
LOOKUP Request\Receive Documentation Status Request\Receive Claim Status Request\Receive Appeals Status Request\Receive Eligibility Info etc
18
Need to build CAQH Transport service (Parallel to XDR) in the CONNECT software by adopting Phase II CORE 270: Connectivity Rule version 2.2.0 specifications.