Electronic Submission of Medical Documentation (esMD) - JA DME

Noridian accepts Medicare's Electronic Submission of Medical Documentation (esMD) transactions from suppliers responding to Additional Documentation Requests (ADRs). The intent of esMD is to:

• Reduce supplier costs and cycle time by minimizing and eventually eliminating paper processing and mailing of medical documentation to review contractors and supports the Centers for Medicare and Medicaid Services’ (CMS) broader eHealth Initiative.
• Reduce costs and time at review contractors.

Any provider or supplier who wants to use esMD to electronically submit supporting medical documentation to a CMS review contractor (RC) must either:

• Build a gateway of their own (and sign up as a Health Information Handler with esMD) or
• Work with a Health Information Handler (HIH) with existing Gateway services.

HIHs are organizations that provide the necessary software and communication services to securely exchange medical documentations between providers and RCs.

A list of HIHs and RCs who participate in esMD services is available on the Medicare Providers and Suppliers website page on the CMS website.

The listing is updated with HIHs that have been approved by CMS to offer esMD services. CMS and Noridian do not set the price that an HIH may charge a provider for esMD services. Suppliers who believe it may be more efficient to respond to documentation requests electronically are encouraged to contact one or more of the HIHs to determine if esMD services are available at a reasonable price. esMD is completely voluntary.

Providers are not required to submit their medical documentation using esMD. Providers may continue to use mail, fax, or the Noridian Medicare Portal (NMP) to submit documentation to Noridian. Additionally, neither CMS nor Noridian will provide reimbursement for any cost or fees for esMD.

Providers and suppliers can use for:

• Prior authorization requests and supporting documentation for Parts A/B and DME
• Paperwork (PWK) documentation for claims
• First and second level appeal requests
• Advanced Determination of Medicare Coverage Requests (ADMC)
• Durable Medical Equipment (DME) phone discussion requests

Resources

• CMS esMD Webpage Including a List of Contractors Participating in esMD
• CMS esMD for Medicare Providers and Suppliers
• CMS esMD for Health Information Handlers (HIH) - Getting Started and Frequently Asked Questions (FAQs)
• CMS Medicare Learning Network (MLN) Matters (MM) 11003 - Implementation to Exchange the List of Electronic Medical Documentation Requests (eMDR) for Registered Providers via the Electronic Submission of Medical Documentation (esMD) System