Digital Hie HIH

Digital HIE is now a HIH (Health Information Handler). Our HIH Solution is capable of receiving claims information in any format and submit to CMS.

Digital HIE Gateway can receive information in custom format in CSV or XML or Flat file and/or standards based HL7 V2.x , HL7 FHIR, EDI X12 files to extract the data and transform the data the way CMS esMD system accepts.

Digital HIE Gateway is hosted in a secured GovCloud environment with FedRAMP security enabled. We have incorporated high security controls to protect the data at rest and in transmission. From Controlled Unclassified Information (CUI), Personally Identifiable Information (PII), sensitive patient medical records, and financial data to law enforcement data, export controlled data and other forms of CUI, AWS GovCloud (US) Regions can help customers address compliance at every stage of their cloud journey.

Digital HIE Gateway supports all the esMD transactions supporting Providers and Hospitals to get paid as soon as possible without any delays.

Need for Additional Documentation:

• Medicare Fee-For-Service (FFS) Program makes billions of dollars in estimated improper payments.
• CMS employs several types of Review Contractors (RCs) to measure, prevent, identify, and correct these improper payments.
• RCs find improper payments by selecting a small sample of claims, requesting and reviewing medical documentation from the provider.
• RCs request medical documentation by sending a paper letter to the provider –Additional Documentation Request (ADR).
• Provider responds with the appropriate documentation –ADR response via Mail/Fax.
• esMD (Electronic Submission of Medical Documentation) was introduced as a secure electronic communication channel for the exchange of supporting documentation between the Providers and RCs.

esMD Overview:

Digital HIE HIH is an esMD Solution (Electronic Submission of Medical Documentation) provides a secure and electronic channel for this exchange between the Provider community and the Review Contractors.

Medicare Fee-For-Service (FFS) providers and suppliers can send the following via Digital HIE HIH:

• Response to Additional Documentation Requests (ADRs).
• First and Second level appeal requests.
• RAC and DME discussion requests.
• Advanced Determination of Medicare Coverage (ADMC) requests.
• Unsolicited claim related documentation.
• Prior Authorization (PA) requests along with supporting documentation.

Medicare Fee-For-Service (FFS) Provider and Suppliers can now receive the following via Digital HIE HIH:

• Prior Authorization Responses
• Electronic Medical Documentation Requests (eMDRs)

Benefits of Using Digital HIE HIH:

                     Review Contractors conduct Improper Payment Reviews to identify, correct and prevent improper payments by selecting a small sample of claims to verify providers compliance with Medicare rules. Digital HIE HIH enables Providers, Suppliers to submit requested documentation electronically to CMS esMD and benefits them as below:

Do you want to get paid soon?

                     As per CMS esMD Program Providers have reported the payment turnaround when using esMD is 6 days as opposed to the paper process which is approximately 3 to 4 weeks.

Do you want to save $$$?

                     As per CMS esMD Program the providers , Suppliers can save the amount of labor required to fulfill these requests, by no longer having to print and mail paper, feed a fax machine or burn CD’s. By using Digital HIE HIH, Providers and Suppliers can also save cost without doing any additional effort in formatting the data and dedicating any resources. Our HIH has capabilities to accept data in any existing format and convert as per the needs of CMS esMD system to process.

Do you want to save more $$$?

 Using CMS esMD providers, suppliers can save hard costs like shipping and handling expenses. Also by utilizing Digital HIE HIH, the hardware and infrastructure costs are saved as well.