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Electronic Submission of Medical Documentation(esMD)Release Summary for the October 2022(AR2022.10.0) ReleaseVersion 1.107/18/2022Document Number: AR2022.10 RelSummaryContract Number: HHSM-500-2016-00068I/75FCMC21F0001
CMS XLCDocument Change HistoryDocument Change ridevi Muthili1.107/18/2022Description of ChangeInitial version of document for AR2022.10.0Updated the following:Sridevi MuthiliRelease Summary for the October 2022 (AR2022.10.0) ReleaseVersion 1.11. Updated Section 2 & 3 with a Note,2. Table 1 updated with new Timelines,3. Table 2 updated with RC/SSM and HIHimpact.iiElectronic Submission of Medical Documentation (esMD)
CMS XLCTable of ContentsTable of Contents1.Overview . 42.Release Approach. 43.Release Schedule . 44.HIH and RC High-Level Impacts for AR2022.10.0. 5List of TablesTable 1: Release Schedule Dates for AR2022.10.0 . 5Table 2: esMD AR2022.10.0 Release Summary. 5Release Summary for the October 2022 (AR2022.10.0) ReleaseVersion 1.1iiiElectronic Submission of Medical Documentation (esMD)
CMS XLC1.OverviewOverviewThe intent of this Electronic Submission of Medical Documentation (esMD) Release Summary Document is to communicateinformation on the release timeline and content to the Health Information Handlers (HIH) and Review Contractors (RC) early in therelease development cycle for the October 03, 2022, esMD Release (AR2022.10.0). 2.Section 2: Provide a high-level perspective of the esMD system functionality being developed and implemented in Productionin AR2022.10.0.Section 3: Release Schedule details the major events and dates that will occur during the release to ensure the HIHs andRCs are prepared to participate in the release. This section also contains a future release notice regarding preparations thatmay be required; andSection 4: HIH and RC High-Level Impacts for details the impacts the change requests (CRs) being implemented inAR2022.10.0 Release may have on the HIHs and RCs.Release ApproachThe October 03, 2022, esMD Release AR2022.10.0 consists of analysis, application, and system changes related to the following(Note: The HOPD regression testing is also expected to be performed along with this CR.):3. Accepting HHPCR Requests with multiple episodes in X12N 278 format via esMD. End to End Testing of Prior Authorization Requests (PAR) submitted via the esMD System in both XDR and X12N 278Formats for all Medicare Part B and DME PA Programs (Ambulance and DMEPOS).Release Schedule DatesThis section lists all the Release Schedule dates, testing timelines and release activities performed by internal and external teams.Refer to Table 1.Note: As part of the AR2022.10.0 release implementation, the RC Client Software do not have any changes and will not bedelivered.Release Summary for the October 2022 (AR2022.10.0) ReleaseVersion 1.14Electronic Submission of Medical Documentation (esMD)
CMS XLCHIH and RC High-Level Impacts for AR2022.10.0Table 1: Release Schedule Dates for AR2022.10.04.Event1. Release Summary Document for the AR2022.10.0 Release delivered to the HIHs and RCsDate07/01/20222. Preliminary HIH Technical Release Changes (TRC) Documents for AR2022.10.0implementation delivered to the HIHs.3. Preliminary RC Technical Release Changes (TRC) Documents for AR2022.10.0implementation delivered to the HIHs.4. Technical call conducted with the RCs to review the AR2022.10.0 release changes5. Technical call conducted with MIST to review the AR2022.10.0 release changes6. Final HIH TRC documents for AR2022.10.0 delivered to the HIHs7. Final RC TRC documents for AR2022.10.0 delivered to the HIHs8. RC Client Application Programming Interface (API) (Java and .NET) software forAR2022.10.0 release delivered to the RCs9. RC Implementation Guides (Java and .NET) for AR2022.10.0 delivered to the RCs10. HIH Implementation Guide for AR2022.10.0 delivered to the HIHs11. X12 275 Companion Guide for AR2022.10.0 release delivered to the HIHs12. X12 278 Companion Guide for AR2022.10.0 release delivered to the HIHs13. Alpha Testing for the AR2022.10.0 release by FISS14. MIST Testing for AR2022.10.0 release by STC15. UAT Timeline16. Code freeze on UAT17. October 2022 Release Go 202208/19/2022NA08/12/202208/05/2022Not in Scope07/29/202207/25/2022 - 08/05/202208/08/2022 - 08/26/202208/29/2022 - 09/21/202209/22/202210/03/2022HIH and RC High-Level Impacts for AR2022.10.0This section lists the impact that will be implemented on the HIHs and RCs in AR2022.10.0. Updates to this Release Summary canbe found in Table 2.Table 2: esMD AR2022.10.0 Release SummaryNumbereChimp CR(12671)/CHG06.2022.10TitleAccepting HHPCRRequests withmultiple episodes inX12N 278 formatvia esMDSub-TypeImplementationRelease Summary for the October 2022 (AR2022.10.0) ReleaseVersion 1.15RC/SSM Impact1. There are no changes or impactfor the RCs as part of thischange request.2. The PA Decision Response sentfrom SSM apart from the existingvalidations on the Header,Trailer and Body of the flat file,the esMD system will startHIH ImpactThe HIH’s are allowed to submita HHPCR X12 278 PA Inboundtransaction with a PDOSspanning across one or morethan one billing period or PDOSspanning across one or morethan one multiple episodes andElectronic Submission of Medical Documentation (esMD)
CMS XLCHIH and RC High-Level Impacts for AR2022.10.0sending the below two new errorcodes for the PDOs multipleepisodes: 811 - Unique TrackingNumber (UTN) value isrepeated across BillingPeriods for the sameesMD Transaction ID 812 - Proposed Date ofService (PDOS) value isrepeated across BillingPeriods for the sameesMD Transaction ID3. The RCs/SSMs are required toparticipate and perform somevalidations during the variousphases of testing activities i.e.,Alpha, MIST/STC and UATtesting.4. The esMD Technical Team willhelp and support the RC’s/SSMto review the test scenarios andidentify any gaps and providesuggestions.5. The esMD Technical Team willsupport in validating whether theintended information and/oroutcome results are correctlyreceived/processed.Note: As a part of this CR, theHOPD regression testing is alsoexpected to be performed.Release Summary for the October 2022 (AR2022.10.0) ReleaseVersion 1.16send it to esMD to be processedto RC’s and SSM. With thisimplementation the 2010EALoop and 2000F Loop of DTPsegment1) The HIH must make sure toprovide the following details inthe DTP 2010EA and 2000FLoop in below 2 conditions:a. The HHPCR request sent forless than or equal to 1 billingperiod.i) The PDOS range at PatientEvent Level must be provided inthe 278 Request.ii) The PDOS range at ServiceLevel (across any ProcedureCode) need not be provided.iii) There can be multipleprocedure codes, but the sameprocedure codes must not berepeated in a record.b. The HHPCR request sent formore than one billing periodi) The PDOS range at thePatient Event Level must beprovided with a holistic range ofBPs.ii) The PDOS range at ServiceLevel must be providedassociated to a ProcedureCodes that are applicable toeach billing period.Electronic Submission of Medical Documentation (esMD)
CMS XLCHIH and RC High-Level Impacts for AR2022.10.0iii) The Procedure Code canbe repeated across differentbilling periods, but each PDOSmust be distinct and not overlap.iv) The PDOS can also havegap between datesv).2) The Procedure code mustalways be unique within thesame records.eChimp CR(12665)End to End Testingof PriorAuthorizationRequests (PAR)submitted via theesMD Systemin both XDR andX12N 278 Formatsfor all MedicarePart B & DME PAProgramsTestingRelease Summary for the October 2022 (AR2022.10.0) ReleaseVersion 1.11. There are no changes as part ofthis change request for the PAPrograms (Ambulance &DMEPOS), but the RCs/SSMsare required to participate andperform some validations for allthe above-mentioned PAPrograms during the variousphases of testing activities i.e.,Alpha, MIST and UAT testing.2. The esMD Technical Team willhelp and support the RC’s/SSMto review the test scenarios andidentify any gaps and providesuggestions.3. The esMD Technical Team willsupport in validating whether theintended information and/oroutcome results are correctlyreceived/processed.7Note: One Billing Period isequal to 30 days.1. There are no changes aspart of this change requestfor the PA Programs(Ambulance & DMEPOS,).But the HIH’s are required todo minimal testing to sendfew XDR and X12 requests,so that the end-to-endtesting is accomplished, andany issues are identified andaddressed during eachtesting phase.Electronic Submission of Medical Documentation (esMD)
As part of the AR2022.10. release, the RC Client Software, Technical Release Documents will be delivered in advance then the below dates along with the ICD document embedded to the RC Implementation Guide for all the new API's (Upload, Download, Status & Notification API's) that are part of the October Release.
