Attachment C-MDR Interfaces and Data Exchanges.pdf
PDF 145 KB Posted
- Attached to
- Medicaid Drug Rebate System (MDR)
- Solicitation number
- 124528 ON
- Issued by
- Lancaster County, Nebraska
About this file
This document is an attachment to a Request for Proposal issued by the State of Nebraska, Department of Health and Human Services, for the Medicaid Drug Rebate System (MDR). The attachment details eighteen primary data interfaces and exchanges required for the MDR system's operation, encompassing the flow of drug rebate-related information between multiple entities including the state's Medicaid Management Information System (MMIS), the Health Insurance Administration (HIA), the Centers for Medicare & Medicaid Services (CMS), managed care organizations (MCOs), pharmacy benefit managers, and third-party vendors such as IQVIA and the Drug Claims Processing Vendor. The interfaces support critical functions including processing of fee-for-service and encounter-based paid drug claims, management of drug formulary data, provider information exchange, supplemental utilization data handling, and generation of rebate-related reports and invoices. Data transmissions occur on quarterly schedules with some interfaces available on-demand or upon request, utilizing transmission methods including Network Data Mover (NDM), SFTP, website downloads and uploads, email, and downloadable portals.
The interfaces predominantly handle proprietary data in various formats specific to the entities involved, with transmission originating from sources such as the MMIS, MDR system itself, and CMS, and directed to destinations including state agencies, labeler manufacturers, and external data analytics companies. Key data exchanges include outbound claims and provider information from MMIS to MDR, inbound rebate offset amounts and labeler lists from CMS to MDR, and bidirectional exchanges of utilization data with CMS. Additional interfaces support specialized functions such as MCO plan unloading for cross-reference file building, detailed claims and invoicing extracts for HIA reporting, and labeler-specific claims files provided to IQVIA for authorized manufacturers. Several interfaces indicate frequencies marked as "TBD," suggesting that implementation details for certain data exchanges remained to be defined during the contract negotiation process.
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Text version
Interface # Interface Name Description Format Frequency Transmission Method From To
MDR1 Drug rebatable FFS Paid Claims Drug rebatable FFS Paid Claims (Outbound) Proprietary Quarterly NDM MMIS MDR
MDR2 Drug rebatable Encounter Paid Claims Drug rebatable Encounter Paid Claims (Outbound) Proprietary Quarterly NDM HIA MDR
MDR3 Drug formulary Data to Drug Rebate MEDI Data file to MDR, Extracted from weekly Drug formulary file from the Drug Claims Processing Vendor. Proprietary Quarterly NDM MMIS MDR
MDR4 Drug rebatable Provider info Drug rebatable Provider info (Outbound) Proprietary Quarterly NDM MMIS MDR MDR5 Drug rebatable Provider NPI info Provider NPI Info (Outbound) Proprietary Quarterly NDM MMIS MDR
MDR6
MCO plan unloaded from the plan table and send to General solutions SQL To Unload from PLAN to build XREF file for Rebates (Plan Number 2000,3000,4000,6000) Proprietary
On Request (Quarterly);
This job should start after 5 P.M. on the day requested to run NDM MMIS MDR
MDR7
Supplemental Utililization Data file and Tag file
This file originates in MDR and is passed through to us. We generate Tag file and data file . Both files are sent to MMA.
Proprietary Quarterly and on Request NDM MDR PDL MDR8 List of Unit Rebate Amounts List of Unit Rebate Amounts Proprietary Quarterly Website Download CMS MDR MDR9 List of Labelers List of Rebatable Labelers Proprietary Quarterly Website Download CMS MDR MDR9b List of Labelers List of Rebatable Labelers Proprietary Quarterly NDM MDR MMIS MDR10 List of Unit Rebate Offset Amount List of Unit Rebate Offset Amount Proprietary Quarterly Website Download CMS MDR MDR11 CMS Drug Rebate Utilization Utilization data for CMS (Data about drug utilization in CMS format) Proprietary Quarterly Website Upload MDR CMS MDR12 CMS Utilization Errors List of errors and alerts when CMS processed the Utilization data Proprietary Quarterly Website Download CMS MDR MDR13 IQVIA Labeler List List of Labelers that the company IQVIA has permission to view Proprietary Quarterly Email IQVIA MDR
MDR14 IQVIA Paid Claims File Paid Claims (in IQVIA format) for Labelers that the company IQVIA has permission to use Proprietary Quarterly SFTP MDR IQVIA
MDR15 MDR Claims Extract Detailed claim level information on drug claims sent to MDR and included or excluded from rebate invoicing Proprietary TBD TBD MDR HIA
MDR16 MDR Invoice/Collection Extract Manufacturer invoice level data on drug rebates invoiced, amounts disputed, and rebates collected Proprietary TBD TBD MDR HIA
MDR17 MDR Drug Info Extract NDC level drug reference information, including rebate status, unit rebate amounts, and other data elements utilized in rebate determination. Proprietary TBD TBD MDR HIA
MDR18 MDR Invoicing Account Reports Claims Level Detail, Invoicing, Accounting Reports Proprietary On Demand Downloadable from Portal MDR Labelers
HIA: Current Data Warehouse
ATTACHMENT C - MDR INTERFACES AND DATA EXCHANGES
RFP# 124528 ON
Medicaid Drug Rebate (MDR) System State of Nebraska, Department of Health and Human Services
MDR Interfaces
File details come from the government source that posted it. Updated .