NE MDR Attachment C_CMS.xlsx

This file is an MDR Interfaces Attachment document from the State of Nebraska Department of Health and Human Services detailing the technical specifications for the Medicaid Drug Rebate System (MDR) under RFP #124528. The attachment outlines eighteen distinct data interfaces required for the MDR system, each with specific parameters regarding data format, transmission frequency, transmission method, and sending/receiving entities. These interfaces facilitate critical drug rebate operations, including the transmission of drug rebatable FFS and encounter paid claims from the MMIS and HIA systems to the MDR system, drug formulary data extraction, provider information and NPI data transfers, MCO plan data management, and supplemental utilization data processing. The interfaces also encompass the receipt of CMS unit rebate amounts and labeler lists via website downloads, the transmission of CMS utilization data via website upload, the sharing of labeler information and paid claims data with third-party vendors such as IQVIA via SFTP and email, and the extraction of detailed claims, invoicing, and drug information data for internal reporting and stakeholder distribution. Most interfaces operate on a quarterly frequency, though some are designated as on-request or on-demand, with transmission methods including NDM (Network Data Mover), SFTP, website portals, and email.

The interfaces utilize proprietary file formats to ensure data security and compliance with federal regulations governing Medicaid drug rebates, including Section 1927 of the Social Security Act and applicable CFR provisions. The interfaces are designed to support the MDR system's core functions of rebate calculation, claims processing, vendor management, and reporting, with defined data flows between the state's MMIS and HIA systems, federal CMS systems, managed care organizations, pharmacy benefit managers, and third-party data analytics vendors. The attachment serves as the technical specification document that bidders must reference to understand the system integration requirements and data exchange protocols necessary for successful implementation and ongoing operation of the MDR system.