Overview of Candidate Standards List

1. Overview of Candidate Standards List esMD Initiative, PPA Workgroup Zeshan A Rajput, MD MS Standards Development Support Team

2. A Quick Introduction to the SDS Team • An S&I Framework communications team specific to standards and their respective organizations • Standards Development Support (SDS) • Reaching out to SDOs • Getting access to standards • Helping locate expertise where necessary • Monitoring for changes to standards • Bringing those changes back to respective SDOs

3. Purpose of this Exercise • The Candidate Standards List serves several functions • Traceability • Was standard ‘X’ considered in this initiative? • When was it excluded and why? (Answered by Harmonization team during Standards Analysis) • Communication • Allows the SDS Team to make sure relevant standards, SDOs, and expertise are available to the initiative • Think of this exercise as a brainstorming session • We want high sensitivity, low specificity • In other words, false positives are okay! • This list is a living document • As the initiative considers new facets, we will update with standards identified that relate to those • This document is not meant to infer design decisions or that a particular standard is a better fit than others

4. What we are asking for • Please review the candidate standards list regularly • More often in pre-discovery and discovery • Less often in implementation, pilots, subsequent phases • Please let us know of any updates • Please let us know how else we can help you • We need your help in making sure we’ve collectively thought of everything we need to consider

5. Use Case 1: CMS Provider Registration –Candidate Standards per Transaction • Content & Structure • X12N 274 • UML • XML • Microdata • Vocab & Code Set • ICD-9-PCS • ICD-10-PCS • LOINC • SNOMED • CPT • Transport & Security • SOAP • UDDI • X.509 • SAML • TLS • Access Services • LDAP • DNS Cross-Functionality Standards, Profiles & Implementations • XDR (C&S) • HPD (C&S) • Direct (T) • PWP (T) • XSPA (Sec) • XUA (Sec) • EUA (Sec) • ATNA (Sec) • CT (Sec) • CONNECT (A) • HCSPD (A) • UPD (A) 4

6. Use Case 1PPA Use Case Context Diagram – CMSProvider Registration Provider Information Directories In to CMS 2. CMS sends ESI query to PD to determine capability of provider / HIH to receive medical documentation request (eMDR). Out from CMS 3. ESI query response sent to CMS Provider / Provider Organization CMS Contractors / Intermediaries esMD Gateway HIH CMS PD Connect 1. HIH/Provider Sends electronic registration request to CMS 4. Confirmation of registration sent from CMS Key : ESI – Electronic Services Information 5

7. Use Case 1: CMS Provider Registration –Candidate Standards per Transaction 6

8. Use Case 1PPA Use Case Context Diagram –Commercial Payer Provider Registration Provider Information Directories In to Payer 2. Payer sends ESI query to PD to determine capability of provider / Agent to receive medical documentation request (eMDR). Out from Payer 3. ESI query response sent to Payer Provider / Provider Organization Commercial Payer Contractors / Intermediaries Gateway Agent Payer PD Connect 1. HIH/Provider Sends electronic registration request to Payer 4. Confirmation of registration status sent from Payer Key : ESI – Electronic Services Information 7

9. Use Case 1: Commercial Payer Provider Registration – Candidate Standards per Transaction 8

10. Use Case 2: Payer sends eMDR to Provider • Content & Structure • X12N 274 • X12N 277 • UML • XML • Microdata • CDA • Vocab & Code Set • ICD-9-PCS • ICD-10-PCS • LOINC • SNOMED • CPT • Transport & Security • SOAP • UDDI • X.509 • SAML • TLS • Access Services • LDAP • DNS Cross-Functionality Standards, Profiles & Implementations • XDR (C&S) • HPD (C&S) • NHIN CAQH CORE X121 • Phase II CORE 2702 • Direct (T) • PWP (T) • XSPA (Sec) • XUA (Sec) • EUA (Sec) • ATNA (Sec) • CT (Sec) • CONNECT (A) • HCSPD (A) • UPD (A) 9

11. Use Case 2PPA Use Case Context Diagram – CMSSecure MDR transmission from Contractor to Provider Provider Information Directories In to Contractor Out from Contractor Out to Provider 3. Sends request to retrieve updated ESI information 4. Receives updated ESI Information 1. Sends request for provider registration status Provider / Provider Organization Contractors / Intermediaries CMS esMD Gateway 2. Receives validation of registration status HIH Connect CMS PD 5. Electronic medical documentation request (MDR) sent securely to Provider or HIH as needed * Key : ESI – Electronic Services Information * Electronic MDR is sent only when CMS identifies the need for documentation. 10

12. Use Case 2: CMS Contractor Sends eMDR to Provider – Candidate Standards per Transaction 11

13. Use Case 2PPA Use Case Context Diagram – Secure eMDRtransmission from Commercial Payer to Provider Provider Information Directories In to Contractor Out from Contractor Out to Provider 3. Sends request to retrieve updated ESI information 4. Receives updated ESI Information 1. Sends request for provider registration status Provider / Provider Organization Contractors / Intermediaries Commercial Payer Gateway 2. Receives validation of registration status Agent Payer PD Connect 5. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed * Key : ESI – Electronic Services Information * eMDR is sent only when Payer identifies the need for documentation. 12

14. Use Case 2PPA Use Case Context Diagram – Secure eMDRtransmission from Commercial Payer to Provider Provider Information Directories 1. Sends request to retrieve updated ESI information Out to Provider 2. Receives updated ESI Information Provider / Provider Organization Contractors / Intermediaries Commercial Payer Gateway Agent Connect Payer PD 3. Electronic medical documentation request (eMDR) sent securely to Provider or Agent as needed * Key : ESI – Electronic Services Information * eMDR is sent only when CMS identifies the need for documentation. 13