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esMD Electronic Medical Documentation Request (eMDR) Metadata

Electronic Medical Documentation Request Metadata Descriptions

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.

esMD to HIH eMDR Post-Pay, Post-Pay-Other, and Pre-Pay XML Structure Metadata Elements

ADR Level Info Loop

Data Element	Short Description	Required/ Optional
Type of eMDR	Type of eMDR	R
Unique Letter Id	Unique identifier for the letter	R
Letter Date	Date of the letter	R

RC System Identifier Details (Occurs ONE Time)

Data Element	Short Description	Required/ Optional
RC System Identifier	Identifier for the RC system	R
Medicare Appeal #	Medicare appeal number	O
CSE #	CSE number of RC System	O

Sender RC Details (Occurs ONE Time)

Data Element	Short Description	Required/ Optional
Organization Name	Name of the sender RC organization	R
Address 1	Primary address of the sender RC	O
Address 2	Secondary address of the sender RC	O
City	City of the sender RC	O
State	State of the sender RC	O
Zip Code	Zip code of the sender RC	O
Telephone (with Extension)	Telephone number and extension	O
e-Mail Address	Email address of the sender RC	O
Web Site Address	Website address of the sender RC	O

Provider Details

Data Element	Short Description	Required/ Optional
Last Name / Organization Name	Provider's last name or organization name	R
Provider NPI	National Provider Identifier of the provider	R
First Name	First name of the provider	O
Middle Name	Middle name of the provider	O
Address 1	Primary address of the provider	O
Address 2	Secondary address of the provider	O
City	City of the provider	O
State	State of the provider	O
Zip Code	Zip code of the provider	O
Provider Number/ PTAN	Provider number or PTAN	O
Fax	Fax number of the provider	O

Letter Details (Occurs ONE Time)

Data Element	Short Description	Required/ Optional
Respond By	Response due date	R
Jurisdiction / Zone of the RC	Jurisdiction or zone of the RC	O
Program name (Line of Business)	Name of the program or line of business	O
Letter Sequence	Sequence number of the letter	O
Previous Letter Date	Date of the previous letter	O
Appeal # Cross Reference	Cross-reference number for the appeal	O
Redetermination	Redetermination details	O
Reconsideration	Reconsideration details	O

Submission Contacts

Data Element	Short Description	Required/ Optional
Contact Name	Name of the contact person	O
Contact Tel and Extension	Telephone number and extension	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	Required/ Optional
Document Code	Code for the document	O
Document Code	Code for the document	O
Inquiry Text 1	First inquiry text	O
Inquiry Text 2	Second inquiry text	O
Inquiry Text 3	Third inquiry text	O
Inquiry Text 4	Fourth inquiry text	O

Claim Details (Can Repeat More Than Once)

Data Element	Short Description	Required/ Optional
Beneficiary ID	Identifier for the beneficiary	O
Claim ID	Identifier for the claim	O
Date Of Service (From)	Start date of the service	O
Date Of Service (To)	End date of the service	O