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Current MMIS Data Flow and Interface Inventory The current MMIS (BASE) facilitates a variety of data integration mechanisms, formats, and schedules in support of IDHW Medicaid enterprise business functions and administrative processes. As an introduction to the current Data Integration Architecture, a conceptual view of information flowing between the BASE system and data partners is provided. The view is organized by the primary data categories of Member, Provider, Claims, Financial, and Reference. In addition, call center data is shown as a distinct extract out of the BASE to Data Warehouse.
Current MMIS Conceptual Data Flow
A detailed list of interfaces operating within the current MMIS Data Integration Architecture are provided below. Each interface is uniquely identified by an interface roster id. Several individual interfaces are used to share data with multiple partners, e.g., 10237_Member.
Current MMIS Interface Inventory
| Interface Name |
| Source |
| Destination |
| Description |
| Delivery Method |
| Delivery Frequency |
| 10037_Bendex |
| IDHW (SSA) |
| BASE |
| Initial and updated information on Title II (Regular Social Security) eligibility and benefits received by the State’s Medicaid members |
| SFTP |
| Daily |
| 10038_BuyIn_A |
| IDHW (CMS) |
| BASE |
| Part A buy-in transactions for selected Idaho Medicaid members. These members are those who receive or who are eligible to receive assistance from DHW with their Medicare premium |
| SFTP |
| Daily |
| 10039_BuyIn_B |
| IDHW (CMS) |
| BASE |
| Part B buy-in transactions for selected Idaho Medicaid members. These members are those who receive or who are eligible to receive assistance from DHW with their Medicare premium |
| SFTP |
| Daily |
| 10041_IBES_Elig_Sys |
| IBES |
| BASE |
| • Record Type 1. Member Demographics |
• Record Type 2. Member Conditions
• Record Type 3. Member Eligibility
• Record Type 4. Member COB (other insurance) information – No longer being used as of 2015
• Record Type 5 Member Living Arrangement and Customer Option
• Record Type 6 Member Share of Cost
• Record Type 9 Member Trailer
| 10042_ICSES_Carrier |
| BASE |
| ICSES |
| Verified third party recovery carrier information |
| VPN direct connection |
| Daily |
| 10080_Warrant_Issue |
| Fiscal |
| BASE |
| Initial payment information for payments made to vendors, clients, or other carriers for various Medicaid services |
| VPN direct connection |
| Daily |
| 10081_Warrant_Status_File |
| Fiscal |
| BASE |
| Updated payment information made by FISCAL to vendors, clients, or other carriers for various Medicaid services. |
| VPN direct connection |
| Daily |
| 10086_CR_SumTran_File |
| BASE |
| Fiscal |
| BARS (Billing and Receipting System) daily cash receipts posted, rolled up by task code (FISCAL accounting code) |
| VPN direct connection |
| Daily |
| 10088_Vendor_File |
| BASE |
| Fiscal |
| Provider pay-to address and Electronic Funds Transfer (EFT) information for provider payments. Two files are created, base to fiscal contains all updates, base to PBA only includes pharmacies/DME vendors |
| VPN direct connection |
| Daily |
| 10088_Vendor_File |
| BASE |
| PBA |
| Provider pay-to address and Electronic Funds Transfer (EFT) information for provider payments. Two files are created, base to fiscal contains all updates, base to PBA only includes pharmacies/DME vendors |
| SFTP |
| Daily |
| 10089_Vendor_IN_File |
| BASE |
| Fiscal |
| Payment requests and detailed accounting information |
| VPN direct connection |
| Weekly |
| 10098_ICSES_Unverified |
| ICSES |
| BASE |
| Insurance and carrier information |
| VPN direct connection |
| Daily |
| 10099_Ins_TPR_ICSES |
| BASE |
| ICSES |
| Third party recovery (TPR) information from the base system that has been verified by Health Management System (HMS), which includes data that originated from ICSES via 10098 ICSES-to-BASE, Insurance Data, IBES, base system User Interface and HMS |
| VPN direct connection |
| Daily |
| 10176_MMIS-COBC |
| COBC |
| BASE |
| Detail-level file received from the Coordination of Benefits Administrator (COBA) in response to the submission of the 10177 COBC eligibility file |
| SFTP |
| Monthly |
| 10177_COBC_Eligibility File |
| BASE |
| COBC |
| Medicare A and Medicare B members that have been eligible for Medicaid within the past two years |
| SFTP |
| Monthly |
| 10199_VS_DOH_DOD |
| Vital Statistics |
| BASE |
| Death date information on members currently on Medicaid |
| SFTP |
| Monthly |
| 10200_Vital_Statistics |
| BASE |
| Vital Statistics |
| All recipients who have had active Medicaid eligibility within the past two years |
| SFTP |
| Monthly |
| 10202_HCIA_Diag |
| Context 4 Healthcare |
| BASE |
| ICD Diagnostic codes (REF Data) |
| SFTP |
| Annually |
| 10203_HCPCS_CPT_Long |
| Context 4 Healthcare |
| BASE |
| AMA (American Medical Association) CPT (Current Procedure Terminology) procedure codes. Long Description |
| SFTP |
| Bi-annually (January and July) |
| 10203_HCPCS_CPT_Short |
| Context 4 Healthcare |
| BASE |
| AMA (American Medical Association) CPT (Current Procedure Terminology) procedure codes. Short Description |
| SFTP |
| Bi-annually (January and July) |
| 10203_HCPCS_Proc_Long |
| Context 4 Healthcare |
| BASE |
| AMA (American Medical Association) HCPCS (Healthcare Common Procedure Coding System) procedure codes. Long Description |
| SFTP |
| Quarterly (January, April, July, and October) |
| 10203_HCPCS_Proc_Short |
| Context 4 Healthcare |
| BASE |
| AMA (American Medical Association) HCPCS (Healthcare Common Procedure Coding System) procedure codes. Short Description |
| SFTP |
| Quarterly (January, April, July, and October) |
| 10219_ACT_CM |
| ACT (IDHW) |
| BASE |
| ACT Case Information |
| SFTP |
| Daily |
| 10223_Drug_Pricing_NDC |
| PBA |
| BASE |
| Drug Pricing Data for NDC Processing |
| SFTP |
| Weekly |
| 10229_Financial_Trans |
| BASE |
| DSS |
| Financial Transactions |
| SFTP |
| Weekly |
| 10232_Prior_Auth |
| BASE |
| DSS |
| Prior Authorization |
| SFTP |
| Daily |
| 10233_BASE-to-DSS |
| BASE |
| DSS |
| Information about Providers, Provider Types, Provider Specialty, Provider Specialties Definitions, Provider Attributes, Affiliations, Plan affiliations, Contracts, Provider enrollment/re-enrollment, Provider Memos, and Carrier information. |
| SFTP |
| Daily |
| 10234_All_Claim |
| BASE |
| DSS |
| EOB related to a claim, claim data values that were overridden to change payment, claim remittance Information, and claim payment information related to claims. |
| SFTP |
| Weekly |
| 10237_Member |
| BASE |
| DSS |
| Information for the maintenance of member demographic information and member relationships or affiliations with subscribers, sponsors, health plans, and providers. The interface also includes demographic information for providers, carriers, etc. A subset of files is also sent to IDHW. |
| SFTP |
| Daily |
| 10237_Member |
| BASE |
| IDHW (IBES) |
| Information for the maintenance of member demographic information and member relationships or affiliations with subscribers, sponsors, health plans, and providers. The interface also includes demographic information for providers, carriers, etc. A subset of files is also sent to IDHW. |
| SFTP |
| Daily |
| 10251_All_Reference |
| BASE |
| DSS |
| Reference data for Medical, Dental, and Surgical Codes and other code sets used in clinical areas of the system |
| SFTP |
| Daily |
| 10261_CLIA |
| CLIA |
| BASE |
| This report helps CMS to monitor regulatory compliance of Lab providers with CLIA (Clinical Laboratory Improvement Amendments), including survey and certification of laboratories, enforcement, and financial management of the program |
| Electronic File |
| Three times/week - Mondays, Wednesdays, and Fridays |
| 10280_CMS_Input |
| BASE |
| IDHW |
| Medicare Savings Program (MSP) premium payment actions that DHW is requesting. These transactions include requests for accretions (additions to the State Buy-in roll), deletions, and changes. |
| SFTP |
| Daily |
| 10282_TPR_Updt_File |
| HMS |
| BASE |
| Third Party Responsibility (TPR) information for Medicaid members |
| SFTP |
| Daily |
| 10300_Taxonomy_Cod_Set |
| WPC |
| BASE |
| WPC (Washington Publishing Company) Taxonomy code set |
| SFTP |
| Bi-annually |
| 10311_All_Callcenter |
| BASE |
| DSS |
| information about calls for providers, members, carriers, and complaint tracking. |
| SFTP |
| Daily |
| 10317_HMS_TPL_Recv_Dis |
| HMS |
| BASE |
| AR (Accounts Receivable) information that is posted in the HMS system for vendors, clients, or other carriers |
| SFTP |
| Weekly |
| 10319_TM_CshRcpt |
| Time Matters |
| BASE |
| Cash receipt information associated with estate recovery, TEFRA recovery, in house casualty recovery, Asset transfer/Set aside motion recoveries, and voluntary payment cash receipts that are posted in the Time Matters system for vendors, clients, or other carriers. |
| SFTP |
| Daily |
| 10330_HMS_Cas_Rcv_Disp |
| HMS |
| BASE |
| AR information associated with casualty recoveries that are posted in the HMS system for vendors, clients, or other carriers. |
| SFTP |
| Daily |
| 10351_CMS_MMIS |
| BASE |
| CMS |
| Low-income-subsidy (LIS) status of dual eligibles, performs auto-assignment of individuals to Medicare Part D plans, counts the number of enrollees for the phased-down state contribution payment, and conveys information on the Part D low-income subsidy determination to CMS |
| SFTP |
| Daily |
| 10352_ASA_Base_Units |
| Context 4 Healthcare |
| BASE |
| Anesthesia Base Unit codes and their associated Medicare with complete historical effective dates |
| SFTP |
| Bi-Annually, January and July |
| 10353_Place_of_Service |
| Context 4 Healthcare |
| BASE |
| Place of Service Code number, Place of Service Name and Place of Service Description |
| SFTP |
| March, July, and November |
| 10354_CDT_Dental_Term |
| Context 4 Healthcare |
| BASE |
| CDT (Current Dental Terminology) Dental procedure codes |
| CD-ROM |
| Annually |
| 10355_RemitRemrk |
| Context 4 Healthcare |
| BASE |
| Valid remittance remarks codes which are used on the 835 electronic remittance advices (RAs) |
| SFTP |
| Tri-Annual |
| 10356 ICD-10 Procedure |
| Context 4 Healthcare |
| BASE |
| ICD-10 Procedure Codes |
| SFTP |
| Annually |
| 10357_Modifiers_Mapping |
| Context 4 Healthcare |
| BASE |
| Modifier codes with complete historical effective dates |
| SFTP |
| Bi-annually (January and July) |
| 10358_Noridian_NDC_Jcodes |
| PBA |
| BASE |
| NDC (National Drug Code) to J-Code crosswalk |
| Web |
| Monthly or on-request |
| 10359_Rev_Cde |
| Context 4 Healthcare |
| BASE |
| Revenue codes |
| CD-ROM/SFTP |
| Bi-annually, in April and October |
| 10360_Type_of_Bill |
| Context 4 Healthcare |
| BASE |
| Type of Bill and Type of Bill Description |
| SFTP |
| March, July, and November |
| 10362_UB_Cond_Code |
| Context 4 Healthcare |
| BASE |
| UB (Uniform Billing Form) Condition code set |
| SFTP |
| Bi-annual, April & October |
| 10363_UB_Occur_Code |
| Context 4 Healthcare |
| BASE |
| UB (Uniform Billing Form) Occurrence code set |
| SFTP |
| Bi-annual, April & October |
| 10364_UB_Value_Code |
| Context 4 Healthcare |
| BASE |
| UB (Uniform Billing Form) Value code set |
| SFTP |
| Bi-annual, April & October |
| 10370_Idaho_Lic |
| Idaho Board of Nursing |
| BASE |
| Licensing for Dentistry, Nursing, Pharmacy, and Physician |
| Email / Web |
| Annually |
| 10370_Idaho_Lic |
| Idaho Board of Medicine |
| BASE |
| Licensing for Dentistry, Nursing, Pharmacy, and Physician |
| Email / Web |
| Annually |
| 10370_Idaho_Lic |
| Idaho Board of Dentistry |
| BASE |
| Licensing for Dentistry, Nursing, Pharmacy, and Physician |
| Email / Web |
| Annually |
| 10370_Idaho_Lic |
| Idaho Board of Pharmacy |
| BASE |
| Licensing for Dentistry, Nursing, Pharmacy, and Physician |
| Email / Web |
| Annually |
| 10371_STUB_Pay_File |
| BASE |
| Fiscal |
| Remittance advice text above each check stub that it creates because of interface 10089 |
| VPN direct connection |
| Weekly |
| 10376_Adjust_Reason |
| Context 4 Healthcare |
| BASE |
| Adjustment Reason code set used on the 835-remittance advice |
| CD-ROM |
| Annually |
| 10378_GPCI_File |
| Context 4 Healthcare |
| BASE |
| Medicare Geographic Practice Cost Index used in conjunction with the RBRVS codes to determine the appropriate reimbursement amounts |
| CD-ROM |
| Quarterly |
| 10380_Eligib |
| BASE |
| DSS |
| Eligibility information |
| SFTP |
| Daily |
| 10380_Eligib |
| BASE |
| IDHW |
| Eligibility information |
| SFTP |
| Daily |
| 10380_Eligib |
| BASE |
| PBA |
| Eligibility information |
| SFTP |
| Daily |
| 10382_Tm_Mtrs_WrtOff |
| Time Matters |
| BASE |
| Estate recovery write-off cash receipt information |
| SFTP |
| Daily |
| 10384_IBES_Alerts |
| BASE |
| IBES |
| Alerts for specific activities that have occurred on a member’s Medicaid record |
| SFTP |
| Daily |
| 10386_TPR_Unverified |
| BASE |
| HMS |
| Unverified third-party responsibility (TPR) information |
| SFTP |
| Daily |
| 10393_IAT_IN_File |
| BASE |
| Fiscal |
| Payment requests for IAT providers |
| VPN direct connection |
| Weekly |
| 10395_NPPES |
| NPPES |
| BASE |
| All the Freedom of Information Act (FOIA) disclosable active provider data in the National Plan and Provider Enumeration System (NPPES). It contains all current NPI activity as well as all updates and changes to provider NPI data. |
| Downloaded zip file |
| Monthly |
| 10396_MMIS_ACT_Respnse |
| BASE |
| ACT |
| Responses back to ACT from processing of the import file 10219 ACT-to-BASE, Case information |
| SFTP |
| Daily |
| 10399_ZipCode9 |
| Context 4 Healthcare |
| BASE |
| Valid zip codes with associated information |
| CD-ROM |
| Quarterly, in January, April, July, and October |
| 10418_CPT_Code_Ingenix |
| Context 4 Healthcare |
| BASE |
| All valid CPT Codes |
| SFTP |
| Quarterly |
| 10419_RvCd-HCPCxwlk-IngTN |
| Context 4 Healthcare |
| BASE |
| All revenue code to all relevant HCPCS code |
| CD-ROM |
| Quarterly |
| 10422_MMA_Response_File |
| IDHW |
| BASE |
| The file is made up of several different record types which can be identified by the Record Identification Code (RIC). These record types include Header Record (RIC SRF), Person-Level Detail Records (RICs DET, LIS and PRO), File Summary Record (RIC FSM), Month Summary Record (RIC MSM) and Trailer (RIC TRL) |
| SFTP |
| Monthly |
| 10428_Errors |
| BASE |
| IBES |
| Errors for specific activities that have occurred because of processing the 10041 |
| SFTP |
| Daily |
| 10450_Prov_Panel |
| BASE |
| PBA |
| Provider (Provider Panel) |
| SFTP |
| Daily |
| 10452_Prov_Load |
| BASE |
| PBA |
| Provider data |
| SFTP |
| Daily |
| 10468_CPT_Rules |
| Context 4 Healthcare |
| BASE |
| CPT codes, switch settings based on input file data, global day values, effective dates, termination dates, and modifier indicators |
| SFTP |
| Annually |
| 10471_CCI_Correct_Code |
| Context 4 Healthcare |
| BASE |
| CCI data consisting of Code combinations, effective dates, termination dates, and modifier indicators |
Quarterly
| 10472_MUE |
| Context 4 Healthcare |
| BASE |
| Claim MUE data consisting of CPT/HCPCS codes and MUE values |
Quarterly
| 10478_IBES_Termination |
| IBES |
| BASE |
| This interface is a workaround to terminate the identified eligibility records in the MMIS system and will be used daily until the IBES team can send them in the eligibility interface. The file will be posted to the MMIS set site and an email notification sent. |
| SFTP |
| Daily |
| 10485_AABD_SSI_Flags |
| IBES |
| BASE |
| All members who have SSI and/or AABD (Aid for Aged, Blind, and Disabled) |
| SFTP |
| Monthly – Nightly – Fourth calendar day of the month |
| 10490_BCI_834_Address |
| BASE |
| BCI |
| 834 (Blue Cross of Idaho) |
| EDI Gateway |
| Monthly |
| 10572_QIO_Prv_Info |
| BASE |
| QIO |
| Provider data |
| SFTP |
| Daily |
| 10574_Context4-to-BASE_HAC |
| Context 4 Healthcare |
| BASE |
| (HAC) Hospital Acquired Condition, to be updated to a receipt table |
| SFTP |
| Annually |
| 10576_Context4-to-BASE_POA_Exclusion_List |
| Context 4 Healthcare |
| BASE |
| POA Exclusion List, with a flag that identifies which codes require a (POA) Present on Admission |
| SFTP |
| Annually |
| 10578_ACT_MMIS_PA |
| ACT (IDHW) |
| BASE |
| Prior Authorization (PA) request data for eligible members |
| SFTP |
| Daily |
| 10579_MMIS_ACT_PA |
| BASE |
| ACT (IDHW) |
| Records whether the PA request was accepted and successfully processed, rejected due to processing errors, or accepted |
| SFTP |
| Daily |
| 10581_Base_TBQ |
| BASE |
| IDHW |
| The Territory Beneficiary Query (TBQ) is a data exchange between CMS and states and territories. States and territories query CMS for Medicare beneficiary eligibility determinations and MBDSS returns a file with this information in the 10582 – TBQ to Base |
| SFTP |
| Daily |
| 10582_CMS_BASE TBQ |
| IDHW (CMS) |
| BASE |
| MBI for all requested members and will be stored by member for the current Medicare segment. |
| SFTP |
| Daily |
| 10584_BASE_to_DSS_PEA Tables |
| BASE |
| DSS |
| Information about the Provider Enrollment Application, including provider demographics, Provider office and facility information, business interest, Medicare and licensing information, DEA certification, EFT banking information, and IRS tax information |
| SFTP |
| Daily |
| 10588_PECOS_TO_Base_Screening |
| PECOS |
| BASE |
| PECOS (Provider Enrollment Chain of Ownership System) Revalidation CSV |
| SFTP |
| Weekly |
| 10591_Idaho_Base_to_EPStaffCheck_License |
| BASE |
| EPStaffCheck |
| Provider license board information from the Idaho Provider Enrollment Application database for any provider with an enrollment status of 32 (Credential Request). |
Daily
| 10592_Idaho_EPStaffCheck_to_Base_License |
| EPStaffCheck |
| BASE |
| A CSV file will be returned from EPStaffCheck for previously submitted providers in the 10591 Base to EPStaffCheck License interface |
| SFTP |
| Daily |
| 10593_ISO_DEA_Updates |
| ISO |
| BASE |
| DEA file |
| SFTP |
| Weekly |
| 10594_MOI_834_Address |
| BASE |
| MOI |
| 834 Address data |
| EDI Gateway |
| Monthly |
| 10596_BCI_to_BASE_Daily_834 |
| BCI |
| BASE |
| 834 Eligibility Data |
| EDI Gateway |
| Daily |
| 10597_MOI_to_BASE_Daily_834 |
| Molina of Idaho |
| BASE |
| 834 Eligibility Data |
| EDI Gateway |
| Daily |
| 10600_PECOS_TO_Base_Owners |
| PECOS |
| BASE |
| PECOS Owners |
| 10601_Idaho_Base_to_EPStaffCheck_Sanctions |
| BASE |
| EPStaffCheck |
| Providers and vendors for exclusion and disciplinary status with Medicare, Medicaid, OIG, State, NPDB and regulatory boards. |
| SFTP |
| Daily |
| 10602_Idaho_EPStaffCheck_to_Base_Sanctions |
| EPStaffCheck |
| BASE |
| Used to monitor providers and vendors for exclusion and disciplinary status with Medicare, Medicaid, OIG, State, NPDB and regulatory boards |
| SFTP |
| Daily |
| 10604_Move_Members_To_Idaho_Medicaid__PhaseII |
| IBES |
| BASE |
| The 10604 will handle the terming of MMCP coverage code when Medicare changes and the subsequent creation of the Idaho Medicaid enhanced coverage code starting in December 2017 for a January 1, 2018 implementation. |
| Result Set |
| Daily |
| 10618_PECOS_TO_Base_Practice_Address |
| PECOS |
| BASE |
| PECOS Practice Address |
| SFTP |
| Monthly |
| 10628_SanData_Provider |
| BASE |
| SanData |
| Provider file |
| SFTP |
| Daily |
| 10629_SanData_DW_Export |
| SanData |
| BASE |
| Provider data containing visit, client, and employee information |
| SFTP |
| Daily |
| 10630_3M_Claims_DRG_Response |
| 3M |
| BASE |
| The purpose of the Claims 3M DRG Response Import interface is to accept response data transactions from the 3M vendor. The transactions are returned from 3M |
| SFTP |
| Daily |
| 10631_3M_Claims_DRG_Extract |
| BASE |
| 3M |
| The purpose of the Claims 3M DRG Request Export interface is to extract data transactions for interaction with the 3M vendor |
| SFTP |
| Monday through Thursday and Saturday |
| 20261_CLIA_PEA |
| CMS |
| BASE |
| This report helps CMS to monitor regulatory compliance of Lab providers with CLIA, including survey and certification of laboratories, enforcement, and financial management of the program |
| Electronic File |
| Mondays, Wednesdays, and Fridays |
| 20395_NPPES |
| NPPES (CMS) |
| BASE |
| All the Freedom of Information Act (FOIA) disclosable active provider data in the NPPES |
| Downloaded zip file |
| Monthly |
| 20450_Prescriber_Data |
| BASE |
| PBA |
| Prescriber Data |
| SFTP |
| Daily |
| 30204_Annual_Clin_Lab_Fees |
| Context 4 Healthcare |
| BASE |
| Medicare pricing for Clinical Lab services |
| CD-ROM |
| Annually |
| 30208_Annual_AMB_ASC_PHY_Fees |
| Context 4 Healthcare |
| BASE |
| Medicaid pricing for Ambulance Transportation (AMB), Ambulatory Surgical Center (ASC), Physicians and Physician Assistant services |
| Electronic File |
| Annually |
| 30487_PBM |
| BASE |
| PBA |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 30573_QIO |
| BASE |
| QIO |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 30577_Dental |
| BASE |
| MCNA |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 35095_MMCP |
| BASE |
| MOI |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 30612_MMCP |
| BASE |
| BCI |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 30613_NEMT |
| BASE |
| MTM |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 30615_BH |
| BASE |
| Optum |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 30616_Vision |
| BASE |
| NVA |
| 834 Eligibility Data |
| EDI Gateway |
| Daily and Monthly |
| 90043_834_Eligibility |
| BASE |
| Vendor |
| 834 Eligibility Data |
| EDI Gateway |
| Daily |
| 90232_Bendex_Error_Response_File |
| BASE |
| IDHW |
| Generated from the MMIS processing results of the records received and errored off in the 10037 DHW-to-BASE BENDEX interface that had MIDs less than 10 digits. |
Quarterly
| 90464_Buy-in |
| BASE |
| DSS |
| Information on Member Buyin via CMS |
| SFTP |
| Daily |
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