esMD supports multiple Lines of Business (LOBs) with the current esMD system setup. As esMD expands to support more features and functionalities that require development of new specifications, a pilot is put in place to implement, take feedback and improve quickly before stabilization. Currently, esMD supports the following four pilots: 

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Consolidated Clinical Documentation Architecture

C-CDA (Consolidated Clinical Document Architecture) is a Health Level Seven (HL7) standard used to define templates for the creation of clinical documents. C-CDA supports the exchange of documentation between multiple parties who are involved in the patient’s care. The standard allows documents to have two components – a human readable section and a machine-readable section. This will bring the review process one step closer to being a computer assisted review. This will reduce the time spent on reviewing each document and ultimately help in resolving claims faster. The goal of the C-CDA pilot is to allow exchange of documents that are in a C-CDA (structured) format. Click here to learn more.

Electronic Medical Documentation Request (eMDR) 

Currently providers and suppliers receive Additional Documentation Request (ADR) letters from RCs by US postal mail. These ADR letters, if received electronically, will reduce the provider and supplier response time and increase efficiency in the ADR review process. The Electronic Medical Documentation Request (eMDR) pilot has been started by the esMD program to enable RCs to send ADR letters electronically via esMD in a structured format to the HIHs representing the respective providers. It is important that the providers and their HIHs register with the participating RC providing their consent to receive eMDRs and provide the destination particulars to be HIPAA compliant.Click here to learn more. 

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Additional Documentation Review (ADR) Results 

Currently RCs send Additional Documentation Request (ADR) letters to healthcare providers. The providers then respond to the RCs with the related documentation using mail, fax, or electronic submission (via their respective HIHs). The RC reviews the documentation and sends the result of the review via mail. To make the process more efficient, a new esMD pilot has been started to allow sending ADR review results electronically.

The ADR review results pilot's goal is for HIHs to be able to recieve electronic responses from RCs, only for those ADR responses that were sent via esMD. The decision date and the review result indicator are part of the results being sent (Reject, Deny or Approve). The ADR review results contains reason codes and statements that provide more specificity and clarity in case of a ‘reject’ or ‘deny’ result. Click here to learn more.