Electronic Submission of Medical Documentation (esMD) Initiative Breakout Session

1. Electronic Submission of Medical Documentation (esMD)Initiative Breakout Session Wednesday, April 11th, 2012 3:00 PM – 6:00 PM

2. esMD F2F Kickoff Agenda

3. Support Team Members • Initiative Coordinator – Sam Elias • CMS Representative - Dan Kalwa • Workgroup Co-leads – Bob Dieterle, Mark Pilley • Project Management Support – Sweta Ladwa, AdjoaDegbo • Use Case Support– Emily Mitchell, Presha Patel • Harmonization Support – Will Ryan, Shay Paintal • Standards Development Support – Anna Langhans, Saunya Williams • Administrative Support – Marcus Imes-Keys, Sallie Miller Introduction of Community Members

4. esMD Initiative Purpose and Scope • Initiative Purpose • To enable the electronic delivery of medical document request letters from payer entities to providers, and identify author-level signature solutions needed to enable acceptance of electronic claims attachments. • Scope • Define the requirements and select the electronic standards necessary to replace current paper processes for medical documentation requests with an electronic alternative.

5. esMD Workgroups

6. Use Cases within each esMD Workgroup

7. esMD Initiative Timeline July ‘12 Oct ‘12 Oct ‘11 Jan ‘12 April ‘12 Pre-Discovery Initiative Charter/Scope Today (4/11/12) Target Initiative Completion: Oct ‘12 11/30-12/7 Charter Consensus Kick-Off/ F2F PPA Workgroup Discovery Implementation Pilot Outline Use Cases & Stories Harmonization/ Standards Analysis of Registration (Use Case #1) Use Case #1: Registration Harmonization/ Standards Analysis of eMDR (Use Case #2) Use Case #2: Sending eMDR Combined Registration/ eMDR Pilots Structured Content WG Harmonization/ Standards Analysis of eMDR (Use Case #2) Use Case #2: Sending eMDR Use Case and Requirements Author of Record WG Harmonization Pilots (TBD) 7 SDS

8. Accomplishments to Date • Achieved Consensus on PPA Use case 1 focusing on provider registration with a payer to receive electronic medical documentation requests (eMDRs) (March 19th, 2012) • Currently working on initial Harmonization activities for PPA Use Case 1. (All Harmonization activities for both Use Case 1 and 2 will be completed together) • We’re two-thirds of the way through in creating the data model for Use Case 1 • Completed drafting various sections of PPA Use Case 2 sections focusing on • Secure Transportation of the eMDR from payer entities (CMS or commercial payers) to a registered provider • Generic User Story, Assumptions, Pre and Post Conditions, Actors and Roles, Activity and Sequence Diagrams, Base flow of information, Functional Requirements and Dataset Requirements • Structured Content of the eMDR from payer entities (CMS or commercial payers) • “Cover letter” portion of the eMDR

9. F2F Objectives and Goals • Use Case • Complete drafting and review of all PPA Use Case 2 sections for end-to-end review by: • Reviewing remaining sections for PPA Use Case 2: • Reviewing Dataset Requirements for the contents of eMDR • Harmonization • Complete initial Harmonization of the PPA UC 1 data elements identified for ‘Registration Request’, ‘Registration Response’ and the relevant ‘Data Objects’

10. F2F Schedule

11. F2F Logistics • Information regarding maps, schedules for the F2F, restaurants, hotel shuttle, etc. can all be found at the registration desk • If you have any issues or questions while at the F2F, please let Sweta Ladwa or Presha Patel know– we’ll be glad to help!

12. Thank You The esMD support staff and coordinators want to thank you for all the hard work you’ve put in to esMD so far, and for taking the time to attend the S&I Framework F2F meeting. We look forward to a meaningful and productive meeting!