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 Metadata Information

esMD Electronic Medical Documentation Request (eMDR) Metadata

Electronic Medical Documentation Request Metadata Descriptions

eMDR Pre-Pay (CTC 2.5) - eMDR Pre-Pay is a process designed to offer convenience to patients who prefer to manage their healthcare costs upfront. It is especially helpful when insurance authorization requires prepayment or when patients wish to avoid surprises by addressing payment before services are provided. This proactive approach ensures smoother financial planning and can help streamline the overall treatment process.

eMDR Post-Pay/Post-Pay-Other (CTC 2.6) - eMDR Post-Pay/Post-Pay-Other is a widely used process, particularly in situations where insurance claims are involved or when patients make payments after receiving services and treatment. This approach allows for the healthcare provider to submit claims to the insurance company first, with the patient paying any remaining balance once the insurance 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.

esMD to HIH eMDR (Pre-Pay, Post-Pay, Post-Pay-Other) XML Structure Data Elements

The following data elements used in eMDRs are summarized in the following table.

ADR Level Info (Occurs ONE Time)

Data Element	Short Description	Format / Values	Length	Usage
Type of eMDR	Type of eMDR	Character Constant Value: 'POST-PAY-OTHER' (One Constant Value)	14	R
Unique Letter Id	Unique identifier for the letter	Character	60	R
Letter Date	Date of the letter	Character Format: mm/dd/yyyy	10	R

RC System Identifier Details (Occurs ONE Time)

Data Element	Short Description	Format / Values	Length	Usage
RC System Identifier	Identifier for the RC system	Character	60	R
Medicare Appeal #	Medicare appeal number	Character	60	O
CSE #	CSE number of RC System	Character	60	O

Sender RC Details (Occurs ONE Time)

Data Element	Short Description	Format / Values	Length	Usage
Organization Name	Name of the sender RC organization	Character	100	R
Address 1	Primary address of the sender RC	Character	75	O
Address 2	Secondary address of the sender RC	Character	75	O
City	City of the sender RC	Character	50	O
State	State of the sender RC	Character Values: All standard 2-character US states value (Postal Code for state Ex: VA, MD, CA, AZ etc.)	2	O
Zip Code	Zip code of the sender RC	Character Formats: 99999-9999	10	O
Telephone (with Extension)	Telephone number and extension of the sender RC	Character Format: 9999999999-9999	18	O
e-Mail Address	Email address of the sender RC	Character	100	O
Web Site Address	Website address of the sender RC	Character	80	O

Provider Details (Occurs ONE Time)

Data Element	Short Description	Format / Values	Length	Usage
Last Name / Organization Name	Provider's last name or organization name	Character	100	R
Provider NPI	National Provider Identifier of the provider	Character Formats: 9999999999	10	R
First Name	First name of the provider	Character	50	O
Middle Name	Middle name of the provider	Character	30	O
Address 1	Primary address of the provider	Character	75	O
Address 2	Secondary address of the provider	Character	75	O
City	City of the provider	Character	50	O
State	State of the provider	Character Values: All standard 2-character value representation for US states	2	O
Zip Code	Zip code of the provider	Character Formats: 99999-9999	10	O
Provider Number/ PTAN	Provider number or PTAN	Character	13	O
Fax	Fax number of the provider	Character Format: 9999999999	10	O

Letter Details (Occurs ONE Time)

Data Element	Short Description	Format / Values	Length	Usage
Respond By	Response due date	Character Formats: mm/dd/yyyy	10	R
Jurisdiction / Zone of the RC	Jurisdiction or zone of the RC	Character Examples: 'QIC Area 1', 'SMRC', 'CERT', 'UPIC Mid-Western', etc.…	50	O
Program name (Line of Business)	Name of the program or line of business	Character Values: (suggested) Part A, Part B, DME, HHH	10	O
Letter Sequence	Sequence number of the letter	Character Values: (suggested) First, Second, etc.…	30	O
Previous Letter Date	Date of the previous letter	Character Formats: mm/dd/yyyy	10	O
Appeal # Cross Reference	Cross-reference number for the appeal	Character	60	O
Redetermination	Redetermination details	Character	80	O
Reconsideration	Reconsideration details	Character	80	O

Submission Contacts (Occurs ONE Time)

Data Element	Short Description	Required/ Optional
Contact Name	Name of the contact person	O
Contact Tel and Extension	Telephone number and extension of the contact person	O
Contact Fax	Fax number of the contact person	O
Contact E-Mail Address	Email address of the contact person	O

Review Level Detail (Occurs ONE Time)

Data Element	Short Description	Format / Values	Length	Usage
Document Code	Code for the document	Character Formats: (999999), (999999999999), (999999999999999999), or -1E+24	24	O
Document Code	Code for the document	Character Formats: (999999), (999999999999), (999999999999999999), or -1E+24	24	O
Inquiry Text 1	First inquiry text	Character	1000	O
Inquiry Text 2	Second inquiry text	Character	1000	O
Inquiry Text 3	Third inquiry text	Character	1000	O
Inquiry Text 4	Fourth inquiry text	Character	1000	O

Claim Details (Can Repeat More Than Once)

Data Element	Short Description	Format / Values	Length	Usage
Beneficiary ID	Identifier for the beneficiary	Character	12	O
Claim ID	Identifier for the claim	Character	23	O
Date Of Service (From)	Start date of the service	Character	10	O
Date Of Service (To)	End date of the service	Character Format: mm/dd/yyyy	10	O