Consolidated Clinical Documentation Architecture
Currently, during the review process, when the RC requests additional documentation from the provider, the documentation is sent by the provider’s HIH via mail or fax. esMD has introduced the ability to send the documentation in an electronic format. However, as the document itself is still in an unstructured pdf format, the RC will need to review these documents manually. Instead, if the documents are in a structured format, they will be machine-readable. This will bring the review process one step closer to being a computer assisted review where human intervention is minimized. This will in turn reduce the time spent on reviewing each document and help in resolving claims faster.
Technical details of the pilot
esMD supports receiving C-CDA documents embedded within the XDR (eXternal Data Representation) profile. The following Lines of Businesses (LOBs) including prior authorization programs, that currently support receiving unstructured documentation in PDF format, will also accept structured documentation in C-CDA:
Response to Additional Documentation Request (ADR)
Supporting Documentation for Prior Authorization Request
This initial rollout of functionality is to accept C-CDA documents and pass it along with the XDR package just as done with the current unstructured PDF attachments embedded in XDR profile (includes preliminary basic validation - virus scan, file type, valid file etc.). The scope includes supporting all the following C-CDA document types as part of the package (one or multiple document types) being sent by the provider through their HIH:
Continuity of Care Document (CCD)
Diagnostic Imaging Report (DIR)
History and Physical (H&P)
What should an HIH do to participate in the C-CDA pilot?
HIHs who are interested in responding with structured C-CDA documents should:
Step 1 - Align on participation in the pilot by communicating with the esMD pilots group at esMDBusinessOwners@cms.hhs.gov
Step 2 - Educate their providers in C-CDA and get alignment in C-CDA participation.
Step 3 - Ensure providers are able to generate C-CDA documents from their EHR system.
Step 4 - Gain the ability to package C-CDA document as an XDR document.
Step 5 - Communicate with esMD support to determine a UAT plan and subsequently plan the quarterly release in which to go live.
Step 6 - Complete testing and go live.