ESMD FHIR Implementation Guide
1.0.0 - esmd
ESMD FHIR Implementation Guide - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
eMDR Pre-Pay (CTC 2.5) - An eMDR Pre-Pay is a formal communication sent by a CMS Review Contractor (RC) to HIHs and Providers that indicates an insurance authorization for medical services requires prepayment before the services are provided. This process offers convenience to patients who prefer to manage their healthcare costs upfront. It is a proactive approach that ensures smoother financial planning and helps to streamline the overall treatment process.
eMDR Post-Pay/Post-Pay Other (CTC 2.6) - An eMDR Post-Pay or eMDR Post-Pay-Other is a formal communication sent by a CMS Review Contractor (RC) to HIHs and Providers in situations where insurance claims are involved or when patients make payments after receiving services and treatment. When using this approach, HIHs and Providers submit claims first, with the patient paying any remaining balance once the insurance review process is completed. It offers flexibility to patients, allowing them to manage costs after treatment, while ensuring that all necessary documentation and claims are processed accurately.
The following metadata elements are used to facilitate the retrieval of document submission metadata and content for eMDR Pre-Pay, Post-Pay, and Post-Pay-Other documents which are stored in the esMD System’s secure storage. eMDR Pre-Pay, Post-Pay, and Post-Pay-Other documents are retrieved by HIHs and Providers from the esMD System’s secure storage using the Esmd-FindDocumentReference and esMD Binary resources.
| esMD Element Name | FHIR Element Name | Cardinality | Element Description |
| letterid | Esmd-Idn-LetterId | 1..1 | A unique identifier that is assigned to each individual eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document that is sent by the RC. It ensures that each eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document can be uniquely identified and tracked throughout the submission and review process. The Letter ID plays a crucial role in preventing duplication, ensuring proper routing, and facilitating accurate processing and auditing of clinical documents that are handled by the esMD system and RCs. |
| esmdtransactionid | Esmd-Ext-TransactionId | 1..1 | A unique identifier which is assigned by the esMD System to each eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document that is received from RCs. The Transaction ID provides clear and efficient tracking for auditing, status reporting, and seamless management of submissions and responses within the esMD workflow. |
| senderoid | Esmd-Ext-OrganizationId | 1..1 | An Organizational Identifier (OID) that uniquely identifies the RC organization that submits an eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document to a receiving HIH/Provider organization using the esMD System. |
| receiveroid | Esmd-Ext-ReceiverOid | 1..1 | An Organizational Identifier (OID) that uniquely identifies the receiving HIH/Provider organization that is the recipient of an eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document when the submitting RC organization uses the esMD System. |
| providernpi | Esmd-Ext-NPI | 0..1 | A unique identification number assigned to healthcare providers who transmit eMDR Pre-Pay, Post-Pay, or Post-Pay-Other documents electronically using the esMD System. The National Provider Identifier (NPI) is used within the esMD System to ensure that PADLs or RRLs are accurately linked to the correct healthcare provider. |
| eMDRType | Esmd-Ext-RequestType | 1..1 | Used during the document retrieval request process to identify the document as an eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document when HIHs or Providers submit a document retrieval request to the esMD System. |
| contenttypecode | Esmd-Ext-LineOfBusinessId | 1..1 | Used to identify the specific Line of Business (LOB) that is associated with the eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document that is retrieved from the esMD System by HIHs or Providers. The LOB ID helps to classify and route submissions based on the type of service or payer-related information, thereby ensuring that eMDR Pre-Pay, Post-Pay, or Post-Pay-Other documents are processed according to the correct business category. |
| creationtime | date ( type- Instant) | 1..1 | Represents the date and time the eMDR Pre-Pay, Post-Pay, or Post-Pay-Other document was created by the esMD System to indicate that the document was ready to download. |
The following metadata elements are used to facilitate the retrieval of document metadata and content for eMDR Pre-Pay, Post-Pay, and Post-Pay-Other documents which are stored in the esMD System’s secure storage. eMDR Pre-Pay, Post-Pay, and Post-Pay-Other documents are retrieved by HIHs and Providers from the esMD System’s secure storage using the Esmd-FindDocumentReference and esMD Binary resources.