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

Esmd System Reference Metadata

esMD System Reference Data

Overview

esMD System Reference Data consists of various lists and categories of information that are critical for ensuring the efficient operation of esMD's document submission and retrieval workflows. esMD System Reference Data is made available to HIHs using esMD's PULL approach and makes use of the esMD Document Retrieval process. This approach makes it easy for HIHs to obtain the system reference data information at their convenience at scheduled intervals, or any time such information has been updated.

esMD System Reference Data consists of the following types of information:

  • Active RC OID List
  • Active Registered NPI List
  • Document Code File
  • PA Procedure Codes List
  • Letter Categories List
  • Response Type Categories List
  • esMD Transaction IDs (With no Provider Acknowledgement)

Information Common to All esMD System Reference Data Files

General Delivery Information

  • The esMD System Reference Data Line of Business (LOB) is identified by Content Type Code (CTC-18).
  • All esMD System Reference Data files are assigned to CTC-18 regardless of the type of information they contain.
  • All esMD System Reference Data files will be delivered to the HIH using the JSON format.
  • The same Transaction ID is assigned to all system reference files which are available for download such that on any given day, the same Transaction ID will be used to PULL (retrieve) multiple system reference files.

esMD System Reference Data Filename Format

More than one system reference data file will be received as part of the same transaction ID. If the metadata received in the DocumentReference resource contains the request type 'Reports', each attachment will have an ID element following this format:

<ReportType>_<HIH_ID>_<YYYYMMDDHHMMSS>

The portion before the first underscore represents the report type, and it allows HIHs to easily identify and save the report accordingly.

esMD System Reference Data attachment ID elements are described as follows:

  • ReportType identifies the specific type of system reference information as follows:
    • ActiveRCOID - Active RC OID List
    • ActiveInactiveNPI - Active Registered NPI List
    • DocumentCodeFile - Document Code File
    • PAProcedureCode - PA Procedure Codes List
    • LetterCategories - Letter Categories List
    • ResponseTypeCategory - Response Type Categories List
    • PendingProviderDeliveryConfirmation - esMD Transaction IDs (With no Provider Acknowledgement)
  • HIH_ID is the HIH’s Organizational Identifier used within the esMD System to identify the HIH.
  • YYYYMMDDHHMMSS represents the report generation timestamp expressed as Year, Month, Day, Hours, Minutes, and Seconds.

esMD System Reference Data File Metadata

Each esMD System Reference Data file contains report metadata which provides the following information about the report:

  • reportType - The type of report being generated
  • generatedDate - The date the report was generated. (Date in YYYY-MM-DD format)
  • totalRecords - The total number of records included in the report.

Note: The Report Metadata fields are used in each system reference file to provide report type, generated date, and total record information.

esMD System Reference Data File Detailed Descriptions

Active RC OID List

The Active RC OID List is a list of Review Contractors which have an active registration status in esMD and have been onboarded to esMD to exchange electronic clinical documents with the requesting HIH.

The Active RC OID List includes the following fields:

Data Element Metadata Name Description
RC Name rcName Represents the name of the Review Contractor.
RC Jurisdiction actualJurisdiction Specifies the jurisdiction linked to the RC.
RC OID rcOid Unique identifier for the Review Contractor.
Supported CTC Values supportedCtcValues Lists the supported content type codes as a collection of strings.

The following is an example of the Active RC OID List JSON.

{
    "reportMetadata": {
        "reportType": "ActiveRCOID",
        "generatedDate": "2024-11-03",
        "totalRecords": 2
    },
    "data": [
        {
            "rcName": "Review Contractor 1",
            "actualJurisdiction": "RAC A",
            "rcOid": "urn:oid:2.16.840.1.113883.13.34.110.1.999.3",
            "supportedCtcValues": "1"
        },
        {
            "rcName": "Test Review Contractor",
            "actualJurisdiction": "MAC JN",
            "rcOid": "urn:oid:2.16.840.1.113883.13.34.110.1.999.7",
            "supportedCtcValues": "8.3, 8.5"
        }
    ]
}

The Active RC OID List will be generated based on the following schedule:

  • A new list will be generated monthly on the first business day of the month at 6:00pm (EST).
  • An updated list will be generated at 6:00pm (EST) on the same business day that there is a change to the existing RC information.

NOTE: Any change that occurs after the 6:00pm (EST) cut-off time will be reflected in the report that is generated on the next business day.

Active Registered NPI List

The Active Registered NPI List is a list of Providers registered for eMDRs by HIHs to exchange documents electronically via esMD.

The Active Registered NPI List includes the following fields:

Data Element Metadata Name Description
Provider NPI providerNpi The provider’s National Provider Identifier (NPI).
Current Enrollment Indicator currentProviderEnrollmentIndicator Indicates the current enrollment indicator.
Previous Enrollment Indicator previousProviderEnrollmentIndicator Indicates the previous enrollment indicator.
Enrollment Change Date enrollmentChangeDate Indicates the enrollment change date of the NPI.
eMDR Success Count emdrSuccessCount Indicates the submission success count.
Active/Inactive Status activeOrInactive Indicates that the NPI is active or inactive.

The following is an example of the Active Registered NPI List JSON.

{
    "reportMetadata": {
        "reportType": "ActiveInactiveNPI",
        "generatedDate": "2024-11-03",
        "totalRecords": 1
    },
    "data": [
        {	
            "providerNpi": "1508352337",
            "currentProviderEnrollmentIndicator": "E",
            "previousProviderEnrollmentIndicator": "B",
            "enrolmentChangeDate": "2024-11-03 21:00:03.170",
            "emdrSuccessCount": "3",
            "activeOrInactive": "Active"
        }
    ]
}

The Active Registered NPI List will be generated based on the following schedule:

  • A new list will be generated monthly on the first business day of the month at 6:00pm (EST).
  • An updated list will be generated at 6:00pm (EST) on the same business day that a new Provider is added (A), an existing provider is edited (E), or an existing provider is removed (R).

NOTE: Any change that occurs after the 6:00pm (EST) cut-off time will be reflected in the report that is generated on the next business day.

Document Code File

The Document Code File List contains a list of Document Codes which are currently listed with an active status within esMD.

The Document Code File List includes the following fields:

Data Element Metadata Name Description
Document Code documentCode A unique code identifying the document type.
Document Code Description documentCodeDescription A brief description of the document type.
Action Flag actionFlag Indicates the current status of the DCF code. The possible values are ‘Added’, ‘Unchanged’, ‘Modified’, ‘Expired’.
Action Date actionDate Date from when the action flag status goes into effect.

The following is an example of the Document Code File JSON:

{
    "reportMetadata": {
        "reportType": "DocumentCodeFile",
        "generatedDate": "2025-03-03",
        "totalRecords": 4
    },
    "data": [
        {
            "documentCode": "100001",
            "documentCodeDescription": "Interim verbal orders",
            "actionFlag": "Unchanged",
            "actionDate": "06-30-2020"
        },
            {
            "documentCode": "100020",
            "documentCodeDescription": "Signed and dated initial and subsequent plan of care/amendment including, short and long term goals with any updates to the plan of care",
            "actionFlag": "Modified",
            "actionDate": "03-03-2025"
        },
        {
            "documentCode": "100009",
            "documentCodeDescription": "Certificate of Terminal Illness",
            "actionFlag": "Expired",
            "actionDate": "02-10-2020"
        },
            {
            "documentCode": "900007",
            "documentCodeDescription": "Imaging Report",
            "actionFlag": "Added",
            "actionDate": "03-03-2025"
        }
    ]
}

The Document Code File List will be generated based on the following schedule:

  • An updated list will be generated at 6:00pm (EST) on the same business day that an amended list is provided by the PCG/Business Team.

NOTE: Any change that occurs after the 6:00pm (EST) cut-off time will be reflected in the report that is generated on the next business day.

PA Procedure Codes List

The PA Procedure Codes List is a list of Prior Authorization Procedure Codes that are active for each of the PA programs which are supported by esMD.

The PA Procedure Codes List includes the following fields:

Data Element Metadata Name Description
PA Program Name paProgramName The name of the PA program.
Lines of Business ID linesOfBunsinessId The Content Type Code (CTC) of the program represented as numeric value.
Procedure Code procedureCode The unique identifier for the medical procedure within the PA program.

The following is an example of the PA Procedure Codes List JSON:

{
    "reportMetadata": {
        "reportType": "PAProcedureCode",
        "generatedDate": "2024-11-03",
        "totalRecords": 3
    },
    "data": [
        {
            "paProgramName": " Requesting Non-Emergent Ambulance Transport",
            "linesOfBunsinessId": 8.1,
            "procedureCode": "A0426"
        },
        {
            "paProgramName": " Home Health Pre-Claim Review request(HHPCR)",
            "linesOfBunsinessId": 8.3,
            "procedureCode": "G0156"
        },
        {
            "paProgramName": " Durable Medical Equipment, Prosthetics/Orthotics & Services",
            "linesOfBunsinessId": 8.4,
            "procedureCode": "E0181"
        }
    ]
}

The PA Procedure Codes List will be generated based on the following schedule:

  • A new list will be generated quarterly on the "Go live day" day of the new quarterly release cycle at 6:00pm (EST) such that it contains all changes that took place during the previous quarterly release cycle.
  • An updated list will be generated at 6:00pm (EST) on the same business day that Procedure Codes are added or removed across the PA Programs supported by esMD.

Letter Categories List

The Letter Categories List is a list of Letter Categories that are actively used by esMD to distinguish between Prior Authorization Decision Letters, Review Results Letters, and Prior Authorization Rejection Letters.

The Letter Categories List includes the following fields:

Data Element Metadata Name Description
Letter Category letterCategory The string value representing the letter category.
Letter Category Description letterCategoryDescription A description of the letter category. (e.g., "Initial Review Letter").

The following is an example of the Letter Categories List JSON:

{
    "reportMetadata": {
        "reportType": "LetterCategories ",
        "generatedDate": "2024-11-03",
        "totalRecords": 4
    },
    "data": [
        {
            "letterCategory": 20.1,
            "letterCategoryDescription": " PA Decision Letter "
        },
        {
            "letterCategory: 20.4,
            "letterCategoryDescription": " Review Results Letter "
        },
        {
            "letterCategory": 20.2,
            "letterCategoryDescription": " PA Rejection Letter "
        },
        {
            "letterCategory": LETTER,
            "letterCategoryDescription": " Letter "
        }

    ]
}

The Letter Categories List will be generated based on the following schedule:

  • A new list will be generated quarterly on the "Go live day" day of the new quarterly release cycle at 6:00pm (EST) such that it contains all changes that took place during the previous quarterly release cycle.
  • An updated list will be generated at 6:00pm (EST) on the same business day that the PCG/Business Team provides an amended list.

Response Type Categories List

The Response Type Categories List is a list of Response Type Categories that are used by esMD to distinguish between Medical Review responses, Non-Medical Review responses, and PA/PCR Request responses.

The Response Type Categories List includes the following fields:

Data Element Metadata Name Description
Response Type Category Decimal responseTypeCategoryDecimal The unique decimal identifier for the response type category.
Response Type Category Description responseTypeCategoryDescription A description of the response type category.

The following is an example of the Response Type Categories List JSON:

{
    "reportMetadata": {
        "reportType": "ResponseTypeCategory",
        "generatedDate": "2024-11-03",
        "totalRecords": 3
    },
    "data": [
        {
            "responseTypeCategoryDecimal": 1.10,
            "responseTypeCategoryDescription": "Medical Review
        },
        {
            "responseTypeCategoryDecimal": 1.11,
            "responseTypeCategoryDescription": "Non – Medical Review"
        },
        {
            "responseTypeCategoryDecimal": 1.12,
            "responseTypeCategoryDescription": "PA – Responses for PA/PCR requests"
        }
    ]
}

The Response Type Categories List will be generated based on the following schedule:

  • A new list will be generated quarterly on the "Go live day" day of the new quarterly release cycle at 6:00pm (EST) such that it contains all changes that took place during the previous quarterly release cycle.
  • An updated list will be generated at 6:00pm (EST) on the same business day that the PCG/Business Team provides an amended list.

esMD Transaction IDs (With no Provider Acknowledgement)

The esMD Transaction IDs Missing eMDR Provider Delivery Confirmation List is a list of esMD Transaction IDs which are associated with transactions that esMD has not received a Provider Delivery Confirmation from the requesting HIH.

The esMD Transaction IDs Missing eMDR Provider Delivery Confirmation List includes the following fields:

Data Element Metadata Name Description
Transaction ID transactionId The unique identifier of the transaction provided by esMD.
Type type The type of eMDR transaction.
Package Delivery Date packageDeliveryDate The date when the package was delivered to the HIH. (Date in YYYY-MM-DD format).
Days Elapsed Without Confirmation daysElapsedWithoutConfirmation The number of days that have elapsed since the package delivery without receiving a Provider Delivery Confirmation from the HIH.

The following is an example of the esMD Transaction IDs (With no Provider Acknowledgement) JSON.

{
    "reportMetadata": {
        "reportType": "PendingProviderDeliveryConfirmation",
        "generatedDate": "2024-11-03",
        "totalRecords": 2
    },
    "data": [
        {
            "transactionId": "TXN123456789012",
            "type": "Pre-Pay",
            "packageDeliveryDate": "2024-10-30",
            "daysElapsedWithoutConfirmation": 4
        },
        {
            "transactionId": "TXN654321098765",
            "type": "Post-Pay",
            "packageDeliveryDate": "2024-10-28",
            "daysElapsedWithoutConfirmation": 6
        }
    ]
}

The esMD Transaction IDs Missing eMDR Provider Delivery Confirmation List will be generated based on the following schedule:

  • The list will be generated twice weekly (Monday and Friday) at 6:00pm (EST) and shall include any Transaction ID which lacks a Provider Delivery Confirmation after three business days have elapsed since esMD delivered the Letter Package to the HIH.
  • An list will also be generated at 6:00pm (EST) on the any business day for any HIH where the count of transactions lacking Provider Delivery Confirmations after three business days have elapsed exceeds 100.

NOTE: Any change that occurs after the 6:00pm (EST) cut-off time will be reflected in the report that is generated on the next business day.