esMD Harmonization UC2 Data E lement Prioritization 8/1/2012

1. esMD HarmonizationUC2 Data Element Prioritization8/1/2012

2. Overview • Karen Shutt, X12 277 SME, identified esMD data elements that are not represented in the 277 Request for Information transaction set • Workgroup leads reviewed and prioritized unrepresented data elements with additional input from Karen Shutt and WEDI members

3. eMDR Message (1/2)

4. eMDR Message (2/2)

5. General Request Information

6. Audit Specific Information

7. Claim Related Information

8. Claim Related Information (Claim Level Detail)

9. Claim Related Information (Line Level Detail)

10. Return Method Object

11. Summary of Analysis (1/3) • Covered: • Date of Request • Scope or Type of Audit • Type of Bill • Purpose of eMDR/ Request Type • Provider Directory Address • Unnecessary: • Individual Provider or Provider Organization Address • Individual Provider Prefix • Request Type Reason • Cover Letter Text • Provider Specialty

12. Summary of Analysis (2/3) • Required: • Payer or Payer Contractor Digital Certificate • Payer or Payer Contractor Signature Artifact • Unique Case Reference Identifier • Performing Provider NPI / Alternate ID / Alternate ID Type • Return Methods • Electronic Service Information • Maximum Electronic Return Size per transaction • Return Constraints • Return Format(s)

13. Summary of Analysis (3/3) • Further Discussion Required: • Payer Organization vs Payer Contractor (Commercial Payers) • Payer Identifier for the Policy holder (Commercial Payers) • Beneficiary Date of Birth (Commercial Payers) • Line Level Diagnosis Code • Provider Directory ID • Maximum Electronic Return Size per transaction • Return Constraints • Program

14. Next Steps Submit Change Request to X12 for Unique Case Reference Identifier Reach out to commercial payers for additional input on TBD Elements Submit Required Elements to WEDI for community review and feedback Submit Return Method Objects to CAQH CORE for review and feedback Reach out to Claim Adjustment Status Code Maintenance Committee for guidance on extensions to R Request Codes in order to communicate authority Update priorities based on input from esMD workgroup members, commercial payers, and WEDI community Submit necessary change requests to X12 Submit necessary change requests to CAQH CORE Submit necessary change requests to Claim Adjustment Status Code Maintenance Committee