S-44300-00017151- MES Attachment_K_MMIS Interface List.xlsx

This is a system integration interface list for the Medicaid Enterprise System (MES) being jointly procured by the State of Oregon, acting through the Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS). The document details 127 system interfaces that must be integrated as part of the MES System Integration Services contract. These interfaces encompass multiple functional categories including Buy-In Medicare processing, claims management through EDI, pharmacy services, drug rebate administration, financial transactions, provider data maintenance, recipient eligibility processing, reference data maintenance, and third-party liability management. The interfaces involve bidirectional, inbound, and outbound data exchanges with external systems including the Centers for Medicare & Medicaid Services (CMS), state agencies such as the Department of Human Services and Board of Nursing, federal systems, and commercial vendors including 3M GPCS, DataNiche, and First Data Bank.

The interfaces support critical Medicaid operations spanning payment processing, claims adjudication, eligibility verification, provider licensing validation, and compliance reporting. Key systems interfaced include HIPAA transaction standards (834 rosters and 820 capitation payments), state eligibility systems (ONE, eXPRS, Integrated Eligibility), federal databases (CMS Eligibility, DOD vital statistics), pharmacy management (POS real-time eligibility, NCPDP standards), and financial reconciliation platforms (CCRS, ACH/EFT processing). The contract requires integration with legacy systems being phased out as well as modern web service architectures using WSDL protocols, indicating a comprehensive modernization of Oregon's Medicaid IT environment while maintaining backward compatibility with existing operational systems.