Attachment Q: - Texas Health and Human Services Commission
advertisement
Texas Health and Human Services Commission RFP No. 529-13-0018 [Date] Attachment Q: Interfaces and Data Elements Analysis This attachment documents inbound interfaces for source systems required by the Enterprise Data Warehouse (EDW) and interfaces needed for outbound publication or subscription of enterprise data. In addition, it documents data elements which the EDW will organize and act as the system of record via data management processes. Finally, it identifies the systems of record external to the EDW. EDW Interfaces Ref # 1 Maps to Existing Business Opportunity * N/A 2 3 Datamart Sub Datamart InterfaceSystem Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Frequency New Business Opp N/A From EDW - Services History by Client,Time Period Outbound MEHIS/Others Internal Web Service Ad-hoc N/A New Business Opp N/A From EDW - Drug History by Client,Time Period Outbound MEHIS/Others Internal Web Service Ad-hoc N/A New Business Opp N/A EDW - Provider History by Client,Time Period Outbound MEHIS/Others Internal Web Service Ad-hoc *Maps to Existing Business Opportunity - Data extraction interface can be reused for system migration **Sizing - Size of one instance of the interface file EDW/BI DD&I Page Q-1 Confidential – Sensitive Procurement Information Texas Health and Human Services Commission RFP No. 529-13-0018 [Date] MFADS Interfaces Ref # Datamart Sub Datamart 1 Maps to Existing Business Opportunity* Yes MFADS N/A 2 No MFADS N/A 3 No MFADS 4 Yes MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Frequency Client File - Client eligibility data and code tables (data originates from HHSC/Systems Application for Verification of Eligibility, Referral, and Reporting (SAVERR) or HHSC/Texas Integrated Eligibility System (TIERS). OPI - for fraud investigative purposes Inbound TIERS/SAVERR - Client Eligibility Internal Secure FTP Monthly Inbound TIERS/SAVERR - Client Eligibility Internal Secure FTP Monthly N/A HHSC Eligibility Recon Extract - Client eligibility reconciliation extract Inbound TIERS/SAVERR - Client Eligibility Internal Secure FTP Monthly N/A LTC data from SAS 1) SAS_AUTH_AGNT_NJ5062 2) SAS_BILL_REF_NJ5081 3) SAS_CLIENT_NJ5063 4) SAS_COMMENT_NJ5064 5) SAS_DIAGNOSIS_NJ5065 6) SAS_DLN_NJ5082 7) Inbound LTC - SAS Internal Secure FTP Monthly Page Q-2 Confidential – Sensitive Procurement Information Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # 5 Maps to Existing Business Opportunity* Yes EDW/BI DD&I Datamart MFADS Sub Datamart N/A [Date] Interface System SAS_DLVD_SERV0_NJ5066 8) SAS_DRCT_PMT_NJ5067 9) SAS_ELGBLTY_NJ5068 10) SAS_ELIG_REF_NJ5083 11) SAS_ENRLMT_NJ5069 12) SAS_LOCATION_NJ5070 13) SAS_LVL_SERV_NJ5071 14) SAS_MED_NCSTY_NJ5072 15) SAS_NAME_NJ5073 16) SAS_OTHER_IDS_NJ5074 17) SAS_PHONE_NO_NJ5075 18) SAS_REF_CDS_NJ5076 19) SAS_SERV_COMB_NJ5084 20) SAS_SERV_EDIT_NJ5085 21) SAS_SERV_ITEM_NJ5078 22) SAS_SERV_PLAN_NJ5079 23) SAS_SERV_REQ_NJ5080 LTC Provider System data 1)PAS_ADDRESS_NK5060 2)PAS_AGNCY_FND_NK5061 3)PAS_BDGT_GRP_NK5062 4)PAS_BDGT_HIST_NK5063 5)PAS_BUDGETS_NK5064 6)PAS_CODETABLE_NK5074 Interface Subsystem Inbound/ Outbound Inbound Provider/ Recipient LTC - PAS Page Q-3 Confidential – Sensitive Procurement Information Internal/ External Internal Media Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Maps to Existing Business Opportunity* Datamart Sub Datamart [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Frequency 7)PAS_CONTRACT_NK5065 8)PAS_COUNTY_NK5066 9)PAS_FACILITY_NK5067 10)PAS_HOLD_HIST_NK5068 11)PAS_HOLD_REL_NK5069 12)PAS_LGL_ENTTY_NK5070 13)PAS_RATE_GRP_NK5071 14)PAS_RATE_HIST_NK5072 15)PAS_RATES_NK5073 16)PAS_SANCTION_NK5075 17)PAS_SERV_CD_NK5076 18)PAS_SERV_EDIT_NK5079 19)PAS_TIN_NK5080 20)PAS_XPD_PMTS_NK5077 21)PAS_XREF_NK5078 6 Yes MFADS N/A 7 Yes MFADS N/A EDW/BI DD&I LTC facility data from the Long Term Care Regulatory Client Assessment Resident Evaluation System (CARES) which contains facility demographic, ownership, licensure, and certification, sanctions, and other similar data LTC client data Inbound LTC - CARES Internal Secure FTP Monthly Inbound LTC Assessment Internal Secure FTP Monthly Page Q-4 Confidential – Sensitive Procurement Information Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 8 Maps to Existing Business Opportunity* Yes MFADS N/A LTC authorization for service Inbound LTC Authorizations Internal Secure FTP Monthly 9 Yes MFADS N/A Inbound Vendor Drug Internal Yes MFADS N/A Inbound Vendor Drug Internal Secure FTP Secure FTP Monthly 10 Adjudicated Claims data and code tables Reference data to include pharmacy, pharmacy address, pharmacy type, NDC, and lockin 11 Yes MFADS N/A Adjudicated Claims data and code tables Inbound Medical Transportation Internal Encrypted Hard Drive Monthly 12 Yes MFADS N/A Provider/Vendor/contract data and code tables Inbound Medical Transportation Internal Encrypted Hard Drive Monthly 13 Yes MFADS N/A Reference files and code tables Inbound Medical Transportation Internal Monthly 14 Yes MFADS N/A BVS deaths data and code tables Inbound BVS (Bureau of Vital Statistics) Internal Encrypted Hard Drive Secure FTP EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-5 Confidential – Sensitive Procurement Information Internal/ External Media Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 15 Maps to Existing Business Opportunity* Yes MFADS N/A THSteps medical screening laboratory data and code tables Inbound THSteps Lab Internal Secure FTP Monthly 16 Yes MFADS N/A THSteps newborn screening data and code table Inbound THSteps Newborn Screening Internal Secure FTP Monthly 17 Yes MFADS N/A Dental provider licensing data and code tables Inbound State Licensing Boards - Dental, Physician, RN/LVN Internal Secure FTP Monthly 18 Yes MFADS N/A MD/DO provider licensing data and code tables Inbound State Licensing Boards - Dental, Physician, RN/LVN Internal Secure FTP Monthly 19 Yes MFADS N/A Board of Nurse Examiners RN licensing data Inbound State Licensing Boards - Dental, Physician, RN/LVN Internal Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-6 Confidential – Sensitive Procurement Information Internal/ External Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 20 Maps to Existing Business Opportunity* Yes Provider/ Recipient Internal/ External MFADS N/A Board of Nurse Examiners LVN licensing data Inbound State Licensing Boards - Dental, Physician, RN/LVN Internal Secure FTP Monthly 21 Yes MFADS N/A Board of Nurse Examiners APN licensing data Inbound State Licensing Boards - Dental, Physician, RN/LVN Internal Secure FTP Monthly 22 Yes MFADS N/A OAG Case List Inbound OAG Cases Internal Monthly MFADS N/A Valid SSN's/Death Match File Inbound Social Security Administration Internal Secure FTP Secure FTP 23 Yes 24 No MFADS N/A Encounters - MFADS - 837 Extract Inbound Vision 21 Internal Monthly 25 No MFADS N/A Encounters - MFADS - Legacy Extract Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 26 No MFADS N/A Encounters - MFADS Member Extract Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Page Q-7 Confidential – Sensitive Procurement Information Media Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 27 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A Encounters - MFADS Provider Extract Inbound Vision 21 Internal Encrypted Hard Drive Monthly 28 No MFADS N/A Encounters - MFADS Reference Extract Inbound Vision 21 Internal Encrypted Hard Drive Monthly 29 No MFADS N/A MFADS – Pricing Benefit Plan Inbound Vision 21 Internal Monthly N/A MFADS – Pricing Benefit Plan SSIM Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 30 No MFADS 31 No MFADS N/A MFADS - Submitted Provider Inbound Vision 21 Internal Monthly No MFADS N/A MFADS - Submitter Information Inbound Vision 21 Internal 33 No MFADS N/A MFADS Acute Care Claim Header Submitted Detail Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 32 34 No MFADS N/A MFADS Appeals Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-8 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 35 Maps to Existing Business Opportunity* No MFADS N/A MFADS Appeals Assignment Claim Inbound 36 No MFADS N/A MFADS Authorization Association Correspondence 37 No MFADS N/A 38 No MFADS 39 No 40 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Authorization Association Diagnosis Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Authorization Association Status Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Authorization Detail Inbound Vision 21 Internal Monthly MFADS N/A MFADS Authorization Detail Assignment Status Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Page Q-9 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 41 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Authorization Detail Period Limit Inbound Vision 21 Internal Encrypted Hard Drive Monthly 42 No MFADS N/A MFADS Authorization Header Inbound Vision 21 Internal Monthly MFADS Authorization Header Inbound Vision 21 Internal N/A MFADS Authorization Role Assignment Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 43 No MFADS N/A 44 No MFADS 45 No MFADS N/A MFADS Billing Inbound Vision 21 Internal Monthly No MFADS N/A MFADS Cash Account Receivable Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 46 47 No MFADS N/A MFADS Cash Account Receivable Disposition Inbound Vision 21 Internal Encrypted Hard Drive Monthly 48 No MFADS N/A MFADS Cash Address Address1 Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-10 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 49 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Cash Address Address3 Inbound Vision 21 Internal Encrypted Hard Drive Monthly 50 No MFADS N/A MFADS Cash Address Address4 Inbound Vision 21 Internal Encrypted Hard Drive Monthly 51 No MFADS N/A MFADS Cash Batch Type Range Inbound Vision 21 Internal Monthly N/A MFADS Cash Case Management Fee Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 52 No MFADS 53 No MFADS N/A MFADS Cash Family Planning Budget (A) Inbound Vision 21 Internal Encrypted Hard Drive Monthly 54 No MFADS N/A MFADS Cash Family Planning Budget Disposition (B) Inbound Vision 21 Internal Encrypted Hard Drive Monthly 55 No MFADS N/A MFADS Cash Family Planning Pay Detail Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-11 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 56 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Cash Financial Institution Inbound Vision 21 Internal Encrypted Hard Drive Monthly 57 No MFADS N/A MFADS Cash Financial Institution Account Inbound Vision 21 Internal Encrypted Hard Drive Monthly 58 No MFADS N/A MFADS Cash Insurance Premium Information Inbound Vision 21 Internal Encrypted Hard Drive Monthly 59 No MFADS N/A MFADS Cash levy Inbound Vision 21 Internal Monthly MFADS N/A MFADS Cash Levy Disposition Inbound Vision 21 Internal No MFADS N/A MFADS Cash Other Pay Assigned Tax Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 60 No 61 62 No MFADS N/A MFADS Cash Other Payee Inbound Vision 21 Internal Monthly 63 No MFADS N/A MFADS Cash Pay Assign Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-12 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Maps to Existing Business Opportunity* Datamart Sub Datamart [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Frequency Drive 64 No MFADS N/A MFADS Cash Pay Assigned Case Management Inbound Vision 21 Internal Encrypted Hard Drive Monthly 65 No MFADS N/A MFADS Cash Pay Assigned Claim header Inbound Vision 21 Internal Encrypted Hard Drive Monthly 66 No MFADS N/A MFADS Cash Pay Assigned Levy Inbound Vision 21 Internal Encrypted Hard Drive Monthly 67 No MFADS N/A MFADS Cash Pay Assigned Payout Inbound Vision 21 Internal Encrypted Hard Drive Monthly 68 No MFADS N/A MFADS Cash Pay Earn Key Inbound Vision 21 Internal Monthly 69 No MFADS N/A MFADS Cash Pay Reissue Inbound Vision 21 Internal 70 No MFADS N/A MFADS Cash Payee Earn Detail Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive EDW/BI DD&I Page Q-13 Confidential – Sensitive Procurement Information Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 71 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Cash Payment 1 Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 72 No MFADS N/A MFADS Cash Payment Assigned Account Receivable 73 No MFADS N/A MFADS Cash Payment Assigned Insurance Co. Inbound Vision 21 Internal Encrypted Hard Drive Monthly 74 No MFADS N/A MFADS Cash Payout Request Inbound Vision 21 Internal Monthly MFADS N/A MFADS Cash Receipt Inbound Vision 21 Internal No MFADS N/A MFADS Cash Receipt Disposition1 Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 75 No 76 77 No MFADS N/A MFADS Cash SOL Request Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-14 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 78 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Cash Stop Payee Request Inbound Vision 21 Internal Encrypted Hard Drive Monthly 79 No MFADS N/A MFADS CLAIM ADDITIONAL DIAGNOSIS Inbound Vision 21 Internal Encrypted Hard Drive Weekly 80 No MFADS N/A MFADS Claim Adjustment Inbound Vision 21 Internal Monthly N/A MFADS Claim Detail Ambulance Inbound Vision 21 Internal MFADS N/A MFADS Claim Detail Asgn Critical Date Span Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 81 No MFADS 82 No 83 No MFADS N/A MFADS Claim Detail Asgn End of Business Inbound Vision 21 Internal Encrypted Hard Drive Monthly 84 No MFADS N/A MFADS Claim Detail Cutback BKT Inbound Vision 21 Internal Encrypted Hard Drive Monthly 85 No MFADS N/A MFADS Claim Detail Dental Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-15 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 86 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Claim Detail Error Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal MFADS Claim Detail Span Date of Service Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 87 No MFADS N/A MFADS Claim Detail file 88 No MFADS N/A 89 No MFADS N/A MFADS Claim Detail STAT AHQP Inbound Vision 21 Internal Encrypted Hard Drive Monthly 90 No MFADS N/A MFADS Claim Header Ambulance Inbound Vision 21 Internal Encrypted Hard Drive Monthly 91 No MFADS N/A MFADS Claim Header Asgn Critical Date Span Code Inbound Vision 21 Internal Encrypted Hard Drive Monthly 92 No MFADS N/A MFADS Claim Header Asgn End Of Business Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-16 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 93 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Claim Header Assigned Status Inbound Vision 21 Internal Encrypted Hard Drive Monthly 94 No MFADS N/A MFADS Claim Header Client Merge Inbound Vision 21 Internal Encrypted Hard Drive Monthly 95 No MFADS N/A MFADS Claim Header Cutback BKT Inbound Vision 21 Internal Encrypted Hard Drive Monthly 96 No MFADS N/A MFADS Claim Header Error Inbound Vision 21 Internal Monthly MFADS N/A MFADS Claim Header Family Planning Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 97 No 98 No MFADS N/A MFADS Claim Header file Inbound Vision 21 Internal Monthly No MFADS N/A MFADS Claim Header Location file Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 99 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-17 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 100 Maps to Existing Business Opportunity* No MFADS N/A MFADS Claim Header STAT AHQP Inbound 101 No MFADS N/A MFADS Claim Header Third Party Resources file 102 No MFADS N/A 103 No MFADS 104 No 105 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Claim Header UB92 Asgn Process Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Claim Header UB92 Assign Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Claim Header UB92 Condition Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Claim Header UB92Inst Per Diem Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-18 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 106 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Claim Miscellaneous Inbound Vision 21 Internal Encrypted Hard Drive Monthly 107 No MFADS N/A MFADS Claim Refund Detail Inbound Vision 21 Internal Encrypted Hard Drive Monthly 108 No MFADS N/A MFADS Client Eligibility SIG/Last Action Code Inbound Vision 21 Internal Encrypted Hard Drive Monthly 109 No MFADS N/A MFADS CMS Accept Reject Message Inbound Vision 21 Internal Encrypted Hard Drive Monthly 110 No MFADS N/A MFADS CMS ADHOC TRIGGER Inbound Vision 21 Internal Encrypted Hard Drive Monthly 111 No MFADS N/A MFADS CMS Adjustment Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 112 No MFADS N/A MFADS CMS Adjustment History Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-19 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 113 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Admin Balance Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 114 No MFADS N/A MFADS CMS Agency Address 115 No MFADS N/A MFADS CMS Billing Combination Inbound Vision 21 Internal Monthly N/A MFADS CMS Budget Inbound Vision 21 Internal MFADS N/A MFADS CMS Claim Audit Inbound Vision 21 Internal No MFADS N/A MFADS CMS Claim Detail Inbound Vision 21 Internal 119 No MFADS N/A MFADS CMS Claim Detail 2 Inbound Vision 21 Internal 120 No MFADS N/A MFADS CMS Claim Detail Adjudication Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 116 No MFADS 117 No 118 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-20 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 121 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Claim Detail Client Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 122 No MFADS N/A MFADS CMS Claim Detail Edit Inbound Vision 21 Internal Monthly MFADS CMS Claim Fiscal Header Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 123 No MFADS N/A 124 No MFADS N/A MFADS CMS Claim Fiscal Warrant Inbound Vision 21 Internal Encrypted Hard Drive Monthly 125 No MFADS N/A MFADS CMS Claim Header Inbound Vision 21 Internal Monthly No MFADS N/A MFADS CMS Claim Header 2 Inbound Vision 21 Internal 127 No MFADS N/A MFADS CMS Claim Header Adjudication Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 126 128 No MFADS N/A MFADS CMS Claim Header Edit Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-21 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 129 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Claim Header NAT Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 130 No MFADS N/A MFADS CMS Claim Hospice Cross Reference 131 No MFADS N/A MFADS CMS Claim Process Inbound Vision 21 Internal Monthly N/A MFADS CMS Claim Reversal Detail Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 132 No MFADS 133 No MFADS N/A MFADS CMS Claim Reversal Header Inbound Vision 21 Internal Encrypted Hard Drive Monthly 134 No MFADS N/A MFADS CMS Claim Special Header Inbound Vision 21 Internal Encrypted Hard Drive Monthly 135 No MFADS N/A MFADS CMS Claim Status Inbound Vision 21 Internal Monthly 136 No MFADS N/A MFADS CMS Claim Suspense Audit Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-22 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 137 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Client Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 138 No MFADS N/A MFADS CMS Client Authorization Agent 139 No MFADS N/A MFADS CMS Client County Inbound Vision 21 Internal Monthly N/A MFADS CMS Client Former Name Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 140 No MFADS 141 No MFADS N/A MFADS CMS Client Level of Service Inbound Vision 21 Internal Encrypted Hard Drive Monthly 142 No MFADS N/A MFADS CMS Client R S Address Inbound Vision 21 Internal Monthly 143 No MFADS N/A MFADS CMS Client Rate Inbound Vision 21 Internal 144 No MFADS N/A MFADS CMS Client Resp Inbound Vision 21 Internal 145 No MFADS N/A MFADS CMS Contract Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-23 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 146 Maps to Existing Business Opportunity* No MFADS N/A MFADS CMS Contract Budget Inbound 147 No MFADS N/A MFADS CMS Contract County 148 No MFADS N/A 149 No MFADS 150 No 151 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS CMS Contract Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS CMS Contract Deduct Detail Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Contract Deduction Detail History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Contract Exp Auth Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-24 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 152 Maps to Existing Business Opportunity* No MFADS N/A MFADS CMS Contract Exp Mth Inbound 153 No MFADS N/A MFADS CMS Contract Format Exception 154 No MFADS N/A 155 No MFADS 156 No 157 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS CMS Contract Hold Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS CMS Contract Hold Detail Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Contract Hold Detail Claim Current Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Contract Hold Detail Claim Final Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-25 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 158 Maps to Existing Business Opportunity* No MFADS N/A MFADS CMS Contract Hold Detail Claim History Inbound 159 No MFADS N/A MFADS CMS Contract Hold Detail History 160 No MFADS N/A 161 No MFADS 162 No 163 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS CMS Contract Rate Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS CMS Contract Reversal List Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Contract Sanction Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Contract Service Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-26 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 164 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Contract Service Group Inbound Vision 21 Internal Encrypted Hard Drive Monthly 165 No MFADS N/A MFADS CMS Contract Sub Inbound Vision 21 Internal Encrypted Hard Drive Monthly 166 No MFADS N/A MFADS CMS Contract Year to Date Payments Inbound Vision 21 Internal Encrypted Hard Drive Monthly 167 No MFADS N/A MFADS CMS County Inbound Vision 21 Internal Monthly MFADS N/A MFADS CMS County Rate Inbound Vision 21 Internal No MFADS N/A MFADS CMS County Region Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 168 No 169 170 No MFADS N/A MFADS CMS Coverage Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-27 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 171 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Deduction Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 172 No MFADS N/A MFADS CMS Deduction Monthly Balance Inbound Vision 21 Internal Encrypted Hard Drive Monthly 173 No MFADS N/A MFADS CMS Deduction Reason Inbound Vision 21 Internal Encrypted Hard Drive Monthly 174 No MFADS N/A MFADS CMS Deduction Status Inbound Vision 21 Internal Encrypted Hard Drive Monthly 175 No MFADS N/A MFADS CMS Deduction Type Inbound Vision 21 Internal Encrypted Hard Drive Monthly 176 No MFADS N/A MFADS CMS Diagnosis Code Conversion Inbound Vision 21 Internal Encrypted Hard Drive Monthly 177 No MFADS N/A MFADS CMS ECMS Submitter Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-28 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 178 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Edit Override Reason Inbound Vision 21 Internal Encrypted Hard Drive Monthly 179 No MFADS N/A MFADS CMS Eligibility Inbound Vision 21 Internal Monthly MFADS CMS Eligibility Category Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 180 No MFADS N/A 181 No MFADS N/A MFADS CMS Event Type Inbound Vision 21 Internal Monthly MFADS N/A MFADS CMS Exped Calc Audit Inbound Vision 21 Internal No MFADS N/A MFADS CMS Fiscal Administrative Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 182 No 183 184 No MFADS N/A MFADS CMS Fiscal Batch Inbound Vision 21 Internal Monthly 185 No MFADS N/A MFADS CMS Fiscal Detail Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-29 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 186 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Fiscal Expedited Payment Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 187 No MFADS N/A MFADS CMS Fiscal Header Inbound Vision 21 Internal Monthly MFADS CMS Fiscal Reference Inbound Vision 21 Internal N/A MFADS CMS Fiscal Sanction Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 188 No MFADS N/A 189 No MFADS 190 No MFADS N/A MFADS CMS Fiscal Warrant Inbound Vision 21 Internal Monthly No MFADS N/A MFADS CMS Fiscal Year Inbound Vision 21 Internal 192 No MFADS N/A MFADS CMS Fund Inbound Vision 21 Internal 193 No MFADS N/A MFADS CMS Hold Deduction Req. Area Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 191 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-30 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 194 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Hold Reason Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal MFADS CMS Hold Type Inbound Vision 21 Internal N/A MFADS CMS Item Inbound Vision 21 Internal MFADS N/A MFADS CMS Level of Service Inbound Vision 21 Internal No MFADS N/A MFADS CMS Level of Service Type Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 195 No MFADS N/A MFADS CMS Hold Status 196 No MFADS N/A 197 No MFADS 198 No 199 200 No MFADS N/A MFADS CMS Managed Care Inbound Vision 21 Internal Encrypted Hard Drive Monthly 201 No MFADS N/A MFADS CMS Managed Care Plan Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-31 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 202 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Medicaid Requirement Inbound Vision 21 Internal Encrypted Hard Drive Monthly 203 No MFADS N/A MFADS CMS Medical Diag Inbound Vision 21 Internal Encrypted Hard Drive Monthly 204 No MFADS N/A MFADS CMS Medical Nec Inbound Vision 21 Internal Monthly N/A MFADS CMS Medical Necessity Code Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 205 No MFADS 206 No MFADS N/A MFADS CMS Miscellaneous Inbound Vision 21 Internal Encrypted Hard Drive Monthly 207 No MFADS N/A MFADS CMS Miscellaneous Hospice Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 208 No MFADS N/A MFADS CMS Modifier Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-32 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 209 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Monthly Util Inbound Vision 21 Internal Encrypted Hard Drive Monthly 210 No MFADS N/A MFADS CMS National Codes Inbound Vision 21 Internal Encrypted Hard Drive Monthly 211 No MFADS N/A MFADS CMS Other Insurance Inbound Vision 21 Internal Monthly N/A MFADS CMS Override Reason Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 212 No MFADS 213 No MFADS N/A MFADS CMS Previous Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 214 No MFADS N/A MFADS CMS Proc Inbound Vision 21 Internal Monthly 215 No MFADS N/A MFADS CMS Procedure Inbound Vision 21 Internal 216 No MFADS N/A MFADS CMS Procedure Code Qualifier Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-33 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 217 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Procedure Rate Inbound Vision 21 Internal Encrypted Hard Drive Monthly 218 No MFADS N/A MFADS CMS Program Claim Type Inbound Vision 21 Internal Encrypted Hard Drive Monthly 219 No MFADS N/A MFADS CMS Program Disposition Inbound Vision 21 Internal Encrypted Hard Drive Monthly 220 No MFADS N/A MFADS CMS Program Edit Inbound Vision 21 Internal Monthly MFADS N/A MFADS CMS Program Edit Disposition Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 221 No 222 No MFADS N/A MFADS CMS Program Mutex Edits Inbound Vision 21 Internal Encrypted Hard Drive Monthly 223 No MFADS N/A MFADS CMS Program Routine Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-34 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 224 Maps to Existing Business Opportunity* No MFADS N/A MFADS CMS Program Routine Edit Level Inbound 225 No MFADS N/A MFADS CMS Program Routine Exception 226 No MFADS N/A 227 No MFADS 228 No 229 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS CMS Program Routine Group Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS CMS Program Routine Script Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Program Routine Script Effect Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Program Type Code Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-35 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 230 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Rate Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal MFADS CMS Retroactive Adjustment Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 231 No MFADS N/A MFADS CMS Retro Neg Budget 232 No MFADS N/A 233 No MFADS N/A MFADS CMS Retroactive Claim Segment Inbound Vision 21 Internal Encrypted Hard Drive Monthly 234 No MFADS N/A MFADS CMS Retroactive Order Inbound Vision 21 Internal Encrypted Hard Drive Monthly 235 No MFADS N/A MFADS CMS Retroactive Recovery Inbound Vision 21 Internal Encrypted Hard Drive Monthly 236 No MFADS N/A MFADS CMS Retroactive Type Criteria Inbound Vision 21 Internal Encrypted Hard Drive Monthly 237 No MFADS N/A MFADS CMS SA Item Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-36 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 238 Maps to Existing Business Opportunity* No MFADS N/A MFADS CMS SA Procedure Inbound 239 No MFADS N/A MFADS CMS Sanction Reason 240 No MFADS N/A 241 No MFADS 242 No 243 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS CMS Service Inbound Vision 21 Internal Monthly N/A MFADS CMS Service Authorization Claim Detail PreAuthorized Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS N/A MFADS CMS Service Group Service Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS CMS Service Group Service Overlap Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-37 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 244 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Service Item Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 245 No MFADS N/A MFADS CMS Service Procedure 246 No MFADS N/A MFADS CMS Srvc Auth Inbound Vision 21 Internal Monthly N/A MFADS CMS Srvc Group Inbound Vision 21 Internal MFADS N/A MFADS CMS State Inbound Vision 21 Internal No MFADS N/A MFADS CMS Submitter Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 247 No MFADS 248 No 249 250 No MFADS N/A MFADS CMS System Program Type Inbound Vision 21 Internal Encrypted Hard Drive Monthly 251 No MFADS N/A MFADS CMS Title XX Elig Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-38 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 252 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS CMS Unit Type Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal MFADS Cross Reference Rule Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 253 No MFADS N/A MFADS Cross Reference 254 No MFADS N/A 255 No MFADS N/A MFADS DRG History Inbound Vision 21 Internal Monthly MFADS N/A MFADS Eligibility Client Inbound Vision 21 Internal No MFADS N/A MFADS ELIGIBILITY CLIENT ASSIGN RISK Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 256 No 257 258 No MFADS N/A MFADS Eligibility Client Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly 259 No MFADS N/A MFADS Eligibility Client Eligibility Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-39 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 260 Maps to Existing Business Opportunity* No MFADS N/A MFADS Eligibility Client Eligibility History Inbound 261 No MFADS N/A MFADS Eligibility Client History 262 No MFADS N/A 263 No MFADS 264 No 265 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Eligibility Client Lock In file Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Eligibility Client Medicare Buy In Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Eligibility Client Medicare Buy in History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS ELIGIBILITY CLIENT RISK CATEGORY HISTORY Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-40 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 266 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Eligibility Family Planning Client Inbound Vision 21 Internal Encrypted Hard Drive Monthly 267 No MFADS N/A MFADS Eligibility Lock In Inbound Vision 21 Internal Monthly MFADS Eligibility Reconciliation File Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 268 No MFADS N/A 269 No MFADS N/A MFADS Full Address Extract Inbound Vision 21 Internal Monthly MFADS N/A MFADS ITP-PCN Inbound Vision 21 Internal No MFADS N/A MFADS Local Codes Crosswalk Inbound Vision 21 Internal 272 No MFADS N/A MFADS National Bill Comb Inbound Vision 21 Internal 273 No MFADS N/A MFADS National Procedure. Inbound Vision 21 Internal 274 No MFADS N/A MFADS NPPES Provider Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard 270 No 271 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-41 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Maps to Existing Business Opportunity* Datamart Sub Datamart [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Frequency Drive 275 No MFADS N/A MFADS NPPES Provider Other Inbound Vision 21 Internal Encrypted Hard Drive Monthly 276 No MFADS N/A MFADS NPPES Taxonomy Inbound Vision 21 Internal Monthly 277 No MFADS N/A MFADS Place of Service Inbound Vision 21 Internal 278 No MFADS N/A MFADS Pricing Action Inbound Vision 21 Internal 279 No MFADS N/A MFADS Pricing ATP Auto Panel Procedure Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 280 No MFADS N/A MFADS Pricing Benefit Plan Pricing Action Inbound Vision 21 Internal Encrypted Hard Drive Monthly 281 No MFADS N/A MFADS Pricing Claim Type Process Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Page Q-42 Confidential – Sensitive Procurement Information Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 282 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Pricing Conversion Factor Inbound Vision 21 Internal Encrypted Hard Drive Monthly 283 No MFADS N/A MFADS Pricing Conversion Factor History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 284 No MFADS N/A MFADS Pricing DRG Pricing Inbound Vision 21 Internal Monthly N/A MFADS Pricing DRG Pricing History Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 285 No MFADS 286 No MFADS N/A MFADS Pricing EOB History Inbound Vision 21 Internal Monthly No MFADS N/A MFADS Pricing Fee Schedule Criteria Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 287 288 No MFADS N/A MFADS Pricing Interim Rate Default Inbound Vision 21 Internal Encrypted Hard Drive Monthly 289 No MFADS N/A MFADS Pricing MCO Approval Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-43 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 290 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Pricing Modifier Copay Inbound Vision 21 Internal Encrypted Hard Drive Monthly 291 No MFADS N/A MFADS Pricing Modifier copay History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 292 No MFADS N/A MFADS Pricing Modifier Reduction Inbound Vision 21 Internal Encrypted Hard Drive Monthly 293 No MFADS N/A MFADS Pricing Modifier Reduction History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 294 No MFADS N/A MFADS Pricing Notation Inbound Vision 21 Internal Monthly No MFADS N/A MFADS Pricing Outlier Inbound Vision 21 Internal No MFADS N/A MFADS Pricing Outlier History Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 295 296 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-44 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 297 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Pricing Plan Provider CIRM Inbound Vision 21 Internal Encrypted Hard Drive Monthly 298 No MFADS N/A MFADS Pricing Plan Provider CIRM History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 299 No MFADS N/A MFADS Pricing Plan Provider CIRM Title Inbound Vision 21 Internal Encrypted Hard Drive Monthly 300 No MFADS N/A MFADS Pricing Procedure Inbound Vision 21 Internal Monthly MFADS N/A MFADS Pricing Procedure ATP Panel Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 301 No 302 No MFADS N/A MFADS Pricing Procedure Clinic Lab Inbound Vision 21 Internal Encrypted Hard Drive Monthly 303 No MFADS N/A MFADS Pricing Procedure Clinic Lab History Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-45 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 304 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Pricing Procedure EOB Inbound Vision 21 Internal Encrypted Hard Drive Monthly 305 No MFADS N/A MFADS Pricing Procedure Flat Fee Inbound Vision 21 Internal Encrypted Hard Drive Monthly 306 No MFADS N/A MFADS Pricing Procedure Flat Fee History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 307 No MFADS N/A MFADS Pricing Procedure Max Fee Inbound Vision 21 Internal Encrypted Hard Drive Monthly 308 No MFADS N/A MFADS Pricing Procedure Max Fee History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 309 No MFADS N/A MFADS Pricing Procedure Notation Inbound Vision 21 Internal Encrypted Hard Drive Monthly 310 No MFADS N/A MFADS Pricing Procedure Notation History Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-46 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 311 Maps to Existing Business Opportunity* No MFADS N/A MFADS Pricing Procedure Pricing TVU History Inbound 312 No MFADS N/A MFADS Pricing Procedure RVU 313 No MFADS N/A 314 No MFADS 315 No 316 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Pricing Procedure Title Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Procedure Title History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Pricing Provider Action Default Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Pricing Provider Action Reduction Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-47 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 317 Maps to Existing Business Opportunity* No MFADS N/A MFADS Pricing Provider Action Reduction Title Inbound 318 No MFADS N/A MFADS Pricing Provider Action Reduction Title History 319 No MFADS N/A 320 No MFADS 321 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Pricing Provider CIRM Per Diem Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Provider CIRM Per Diem History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Provider CIRM Tiered DRG Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-48 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 322 Maps to Existing Business Opportunity* No MFADS N/A MFADS Pricing Provider CIRM Tiered DRG History Inbound 323 No MFADS N/A MFADS Pricing Provider Enroll 324 No MFADS N/A 325 No MFADS 326 No 327 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Pricing Provider Interim Rate Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Provider Interim Rate History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Pricing Provider Level 1 Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Pricing Provider Level 1 History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-49 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 328 Maps to Existing Business Opportunity* No MFADS N/A MFADS Pricing Provider level 2 Inbound 329 No MFADS N/A MFADS Pricing Provider level 2 History 330 No MFADS N/A 331 No MFADS 332 No 333 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Pricing Provider Notafication Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Provider Price Action Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Pricing Provider Price Action History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Pricing Provider SDA Peer Group Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-50 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 334 Maps to Existing Business Opportunity* No MFADS N/A MFADS Pricing Provider SDA Peer Group History Inbound 335 No MFADS N/A MFADS Pricing Provider Sole Community 336 No MFADS N/A 337 No MFADS 338 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Pricing Provider Sole Community History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Provider Type Speciality and Subspecialty Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Pricing Reduct Exclude Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-51 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 339 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Pricing Reduct Exclude History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 340 No MFADS N/A MFADS Pricing Request Type Inbound Vision 21 Internal Encrypted Hard Drive Monthly 341 No MFADS N/A MFADS Pricing Universal Mean Inbound Vision 21 Internal Encrypted Hard Drive Monthly 342 No MFADS N/A MFADS Pricing Universal Mean History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 343 No MFADS N/A MFADS Provider Inbound Vision 21 Internal Monthly No MFADS N/A MFADS PROVIDER ADDRESS 2 Inbound Vision 21 Internal 345 No MFADS N/A MFADS Provider Address file Inbound Vision 21 Internal 346 No MFADS N/A MFADS Provider Address1 Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 344 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-52 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 347 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Provider As Enroll Status file Inbound Vision 21 Internal Encrypted Hard Drive Monthly 348 No MFADS N/A MFADS Provider Assigned Program file Inbound Vision 21 Internal Encrypted Hard Drive Monthly 349 No MFADS N/A MFADS Provider Assigned Program Managed Care Plan file Inbound Vision 21 Internal Encrypted Hard Drive Monthly 350 No MFADS N/A MFADS Provider Association1 Inbound Vision 21 Internal Encrypted Hard Drive Monthly 351 No MFADS N/A MFADS Provider Association3 Inbound Vision 21 Internal Encrypted Hard Drive Monthly 352 No MFADS N/A MFADS Provider Association4 Inbound Vision 21 Internal Encrypted Hard Drive Monthly 353 No MFADS N/A MFADS Provider Association5 Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-53 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 354 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Provider Back-up with Hold Notice1 Inbound Vision 21 Internal Encrypted Hard Drive Monthly 355 No MFADS N/A MFADS Provider Enrollment file Inbound Vision 21 Internal Encrypted Hard Drive Monthly 356 No MFADS N/A MFADS Provider Family Planning Title Assigned Provider Program Inbound Vision 21 Internal Encrypted Hard Drive Monthly 357 No MFADS N/A MFADS Provider file Inbound Vision 21 Internal Monthly MFADS N/A MFADS Provider Group file Inbound Vision 21 Internal No MFADS N/A MFADS Provider Group Member file Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 358 No 359 360 No MFADS N/A MFADS Provider Group Type file Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-54 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 361 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Provider Identifier file Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal MFADS Provider Locality Inbound Vision 21 Internal N/A MFADS Provider Longterm Billing Method file Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 362 No MFADS N/A MFADS Provider License file 363 No MFADS N/A 364 No MFADS 365 No MFADS N/A MFADS Provider Longterm Dispro Share file Inbound Vision 21 Internal Encrypted Hard Drive Monthly 366 No MFADS N/A MFADS Provider Longterm Electronic Bill Program file Inbound Vision 21 Internal Encrypted Hard Drive Monthly 367 No MFADS N/A MFADS Provider Longterm Hospital Capaciaty file Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-55 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 368 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Longterm Imposed Sanction file Inbound 369 No MFADS N/A MFADS Provider Longterm Program Asgn Address Type file 370 No MFADS N/A 371 No MFADS 372 No 373 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Longterm Vendor Hold file Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Managed Care Plan Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Provider NPI Inbound Vision 21 Internal Monthly MFADS N/A MFADS Provider NPI Additional Taxonomy Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Page Q-56 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 374 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider NPI Additional Taxonomy History Inbound 375 No MFADS N/A MFADS Provider NPI Assigned Practice Location 376 No MFADS N/A 377 No MFADS 378 No 379 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider NPI Assigned Practice Location History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider NPI History Inbound Vision 21 Internal Monthly MFADS N/A MFADS Provider NPI Master Crosswalk Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS N/A MFADS Provider Ownership Accounting Address Explanation Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-57 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 380 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Ownership Address Association Table Inbound 381 No MFADS N/A MFADS Provider Ownership Address Table 382 No MFADS N/A 383 No MFADS 384 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Ownership Address Type Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Ownership Citizen Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Ownership License Issuer Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-58 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 385 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Ownership License Table Inbound 386 No MFADS N/A MFADS Provider Ownership License Type Table 387 No MFADS N/A 388 No MFADS 389 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Ownership Other ID Type Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Ownership Owners Address Association Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Ownership Owners Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-59 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 390 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Ownership Owners Type Code Table Inbound 391 No MFADS N/A MFADS Provider Ownership Principal Address Association Table 392 No MFADS N/A 393 No MFADS 394 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Ownership Principal Association Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Ownership Principal License Association Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Ownership Principal Other ID Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-60 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 395 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Ownership Principal Subcontractor Information Table Inbound 396 No MFADS N/A MFADS Provider Ownership Principal Subcontractor Relationship Table 397 No MFADS N/A 398 No MFADS N/A EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Ownership Principal Subcontractor Relationship Type Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Ownership Principal Subcontractor Type Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-61 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 399 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Ownership Record Type Code Table Inbound 400 No MFADS N/A MFADS Provider Ownership Table 401 No MFADS N/A 402 No MFADS 403 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Ownershp Entity Type Code Table Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Practice Location Assigned Address Usage Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Practice Location Assigned Benefit Code Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-62 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 404 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Practice Location Assigned Benefit Code History Inbound 405 No MFADS N/A MFADS Provider Practice Location Assigned Taxonomy Code 406 No MFADS N/A 407 No MFADS 408 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Practice Location Assigned Taxonomy Code History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Practice Location file Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Practice Location FQHC Grant Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-63 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 409 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Practice Location Lock in Inbound 410 No MFADS N/A MFADS Provider Practice Location Mammography Certification 411 No MFADS N/A 412 No MFADS 413 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Practice location on Review Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Practice Location payment Frequency Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider practice Location Program Assigned Address Type1 Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-64 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 414 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Practice Location Program Assigned Tax Inbound 415 No MFADS N/A MFADS Provider Practice Location Program Electronic Remittance and Status 416 No MFADS N/A 417 No MFADS 418 No 419 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Senate Bill 30 Data Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Provider Specialty Inbound Vision 21 Internal Monthly MFADS N/A MFADS Provider State Share Certification of Funds Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS N/A MFADS Provider Sub Specialty Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-65 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 420 Maps to Existing Business Opportunity* No MFADS N/A MFADS Provider Tax Information file Inbound 421 No MFADS N/A MFADS Provider Type / Specialty - Sub Specialty Crosswalk 422 No MFADS N/A 423 No MFADS 424 No 425 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Provider Type Sub Specialty file Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Assigned Claim Type Media Source Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Assigned Paper Claim Media Source Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Behavioral Health Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-66 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 426 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Reference Comment Inbound Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 427 No MFADS N/A MFADS Reference Comment Rule 428 No MFADS N/A MFADS Reference Designer Edit Audit Claim Criteria Inbound Vision 21 Internal Encrypted Hard Drive Monthly 429 No MFADS N/A MFADS Reference Designer Edit Audit Disposition Criteria Inbound Vision 21 Internal Encrypted Hard Drive Monthly 430 No MFADS N/A MFADS Reference Designer Edit List Inbound Vision 21 Internal Encrypted Hard Drive Monthly 431 No MFADS N/A MFADS Reference Diagnosis Inbound Vision 21 Internal Monthly No MFADS N/A MFADS Reference Diagnosis Group Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive 432 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-67 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 433 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Diagnosis Group History Inbound 434 No MFADS N/A MFADS Reference Diagnosis Group Type 435 No MFADS N/A 436 No MFADS 437 No 438 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Diagnosis History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Diagnosis Manifestions Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Diagnosis Manifestions History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Diagnosis Related Group Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-68 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 439 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Reference Diagnosis Related Group History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 440 No MFADS N/A MFADS Reference Diagnosis Restrictions Inbound Vision 21 Internal Encrypted Hard Drive Monthly 441 No MFADS N/A MFADS Reference Diagnosis Restrictions History Inbound Vision 21 Internal Encrypted Hard Drive Monthly 442 No MFADS N/A MFADS Reference DRG Inbound Vision 21 Internal Monthly MFADS N/A MFADS Reference DRG Group Inbound Vision 21 Internal No MFADS N/A MFADS Reference DRG Group History Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 443 No 444 445 No MFADS N/A MFADS Reference Easy Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-69 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 446 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Easy Registration Inbound 447 No MFADS N/A MFADS Reference Edit Audit Audit ID History 448 No MFADS N/A 449 No MFADS 450 No 451 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Edit Audit Bypass Number Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit Claim Criteria Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Edit Audit Code Disp Crit Field Priority Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Edit Audit common Criteria Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-70 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 452 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Edit Audit common Criteria History Inbound 453 No MFADS N/A MFADS Reference Edit Audit common Criteria Rule 454 No MFADS N/A 455 No MFADS 456 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Edit Audit Critical Field Priority Field History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit Disposition Criteria Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit Disposition Criteria History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-71 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 457 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Edit Audit Disposition EOB EOP Inbound 458 No MFADS N/A MFADS Reference Edit Audit Disposition EOB EOP History 459 No MFADS N/A 460 No MFADS 461 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Edit Audit Disposition EOB EOPS History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit Edit Criteria Indicators Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit Edit Criteria Indicators History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-72 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 462 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Edit Audit Edit Criteria Rule Inbound 463 No MFADS N/A MFADS Reference Edit Audit Edit List 464 No MFADS N/A 465 No MFADS 466 No 467 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Edit Audit Edit List membership Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit Edit list Pre Request Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Edit Audit EOB EOPS Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Edit Audit EOB EOPS History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-73 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 468 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Edit Audit Group Detail Inbound 469 No MFADS N/A MFADS Reference Edit Audit Group Detail History 470 No MFADS N/A 471 No MFADS 472 No 473 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Edit Audit Holiday Calendar Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Edit Audit ID Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Edit Audit ID History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Edit Audit Media Source Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-74 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 474 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Edit Audit Media Source History Inbound 475 No MFADS N/A MFADS Reference Edit Audit Procedure Cross Reference 476 No MFADS N/A 477 No MFADS 478 No 479 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Edit Bypass Inbound Vision 21 Internal Monthly N/A MFADS Reference Edit/Audit Audit ID Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS N/A MFADS Reference Explanation of Benefits Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Lab Certification Procedure Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-75 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 480 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Lab Certification Procedure History Inbound 481 No MFADS N/A MFADS Reference Modifier 482 No MFADS N/A 483 No MFADS 484 No 485 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Monthly MFADS Reference Modifier Group Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive N/A MFADS Reference Modifier Group History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Modifier Group View Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Modifier History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-76 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 486 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Plan Procedure Pre Post Care Inbound 487 No MFADS N/A MFADS Reference Podiatry Pricing 488 No MFADS N/A 489 No MFADS 490 No 491 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Inbound Vision 21 Internal Monthly N/A MFADS Reference Procedure Authorization Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS N/A MFADS Reference Procedure Authorization History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Authorization Required Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-77 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 492 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Authorization Required History Inbound 493 No MFADS N/A MFADS Reference Procedure Conversion 494 No MFADS N/A 495 No MFADS 496 No 497 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Conversion History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Procedure Conversion ID History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Conversion Provider Type Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Diagnosis Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-78 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 498 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Diagnosis Covered Inbound 499 No MFADS N/A MFADS Reference Procedure Diagnosis Covered History 500 No MFADS N/A 501 No MFADS 502 No 503 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Diagnosis History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Procedure Group Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Group History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Group View Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-79 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 504 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Grouping History Inbound 505 No MFADS N/A MFADS Reference Procedure History 506 No MFADS N/A 507 No MFADS 508 No 509 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Modifier Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Procedure Modifier History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Place of Service Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Place of Service History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-80 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 510 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Place of Service Provider Specialty Inbound 511 No MFADS N/A MFADS Reference Procedure Place of Service Provider Specialty History 512 No MFADS N/A 513 No MFADS N/A EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Place of Service Provider Subspecialty Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Place of Service Provider Subspecialty History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-81 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 514 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Place of Service Provider Type Inbound 515 No MFADS N/A MFADS Reference Procedure Place of Service Provider Type History 516 No MFADS N/A 517 No MFADS 518 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Program Benefit Plan Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Procedure Restriction Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Procedure Restriction History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-82 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 519 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Source Code Inbound 520 No MFADS N/A MFADS Reference Procedure Subsequent Procedure 521 No MFADS N/A 522 No MFADS 523 No 524 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Procedure Subsequent Procedure History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Procedure Suffix ID History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Surface Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Procedure Tooth Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-83 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 525 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Procedure Tooth History Inbound 526 No MFADS N/A MFADS Reference Program 527 No MFADS N/A 528 No MFADS 529 No 530 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Monthly MFADS Reference Program Benefit Plan Cross Walk Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive N/A MFADS reference Program Benefit Plan DRG Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Program Benefit Plan DRG History Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Program Benefit Plan History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-84 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 531 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Program Benefit Plan Procedure Inbound 532 No MFADS N/A MFADS Reference Program Benefit Plan Procedure History 533 No MFADS N/A 534 No MFADS 535 No 536 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Program History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Texas County Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Type of Service Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Reference Type of Service History Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-85 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 537 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Type of Service Modifier Inbound 538 No MFADS N/A MFADS Reference Type of Service Modifier History 539 No MFADS N/A 540 No MFADS 541 No MFADS EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Type of Service Procedure Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Type of Service Procedure History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Type of Service Procedure Modifier Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-86 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 542 Maps to Existing Business Opportunity* No MFADS N/A MFADS Reference Type of Service Procedure Modifier History Inbound 543 No MFADS N/A MFADS Reference Type of Service Provider Type 544 No MFADS N/A 545 No MFADS 546 No 547 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Reference Type of Service Provider Type History Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Reference Validation Inbound Vision 21 Internal Monthly MFADS N/A MFADS Reference Validation Register Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS N/A MFADS Reference Zip Cross Reference Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-87 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 548 Maps to Existing Business Opportunity* No MFADS N/A MFADS Revenue Inbound 549 No MFADS N/A MFADS SUBMITTED CLAIM DETAIL 550 No MFADS N/A 551 No MFADS 552 No 553 No EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Monthly Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive MFADS Third Party Resource insurance Company Inbound Vision 21 Internal Encrypted Hard Drive Monthly N/A MFADS Third Party Resources Association Client Review Claim Type Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Third Party Resources Client Insurance Coverage Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS N/A MFADS Third Party Resources Client Insurance Policy Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-88 Confidential – Sensitive Procurement Information Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 554 Maps to Existing Business Opportunity* No Internal/ External Media MFADS N/A MFADS Third Party Resources Client Review Inbound Vision 21 Internal Encrypted Hard Drive Monthly 555 No MFADS N/A MFADS Third Party Resources Client Review Place of Service Inbound Vision 21 Internal Encrypted Hard Drive Monthly 556 No MFADS N/A MFADS Third Party Resources Type of Coverage Inbound Vision 21 Internal Encrypted Hard Drive Monthly 557 No MFADS N/A MFADS TORT Case Inbound Vision 21 Internal Monthly MFADS N/A MFADS TORT Case Contact Inbound Vision 21 Internal No MFADS N/A MFADS TORT Case Form Inbound Vision 21 Internal No MFADS N/A MFADS TORT Case Source of Reference Inbound Vision 21 Internal Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive Encrypted Hard Drive 558 No 559 560 EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Page Q-89 Confidential – Sensitive Procurement Information Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 561 Maps to Existing Business Opportunity* No MFADS N/A MFADS Treatment Authorization Request System Inbound 562 No MFADS N/A MFADS Treatment Authorization Request System Recovery 563 No MFADS N/A 564 No MFADS N/A EDW/BI DD&I Interface System Interface Subsystem Inbound/ Outbound Provider/ Recipient Internal/ External Media Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Treatment Authorization Request System, TORT, and Third Party Resources Address1 Inbound Vision 21 Internal Encrypted Hard Drive Monthly MFADS Treatment Authorization Request System, TORT, and Third Party Resoures Address Inbound Vision 21 Internal Encrypted Hard Drive Monthly Page Q-90 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # [Date] Datamart Sub Datamart 565 Maps to Existing Business Opportunity* No Interface System Interface Subsystem Inbound/ Outbound MFADS N/A MFADS Voucher History Table Inbound 566 No MFADS N/A MFADS Voucher Table Layout Interface System Provider/ Recipient Internal/ External Media Frequency Vision 21 Internal Encrypted Hard Drive Monthly Inbound Vision 21 Internal Encrypted Hard Drive Monthly Inbound/ Outbound Provider/Recipient Internal/ External Vision 21 Interfaces Ref # Datamart Sub Datamart 1 Maps to Existing Business Opportunity * No Vision 21 CMS DADS_LTC_Clients.xls Inbound DADS Internal 2 No Vision 21 MAR/STAT DBMD Nonwaiver Recipients Inbound DADS Internal 3 No Vision 21 DRA DRA - DARS Provider/Entity Payment Information File Inbound Other Internal EDW/BI DD&I Interface Subsystem Page Q-91 Confidential – Sensitive Procurement Information Media Frequency Secure FTP Secure FTP Monthly Secure FTP Biennial (Even Numbered Years) Annually Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 4 Maps to Existing Business Opportunity * No Vision 21 DRA 5 No Vision 21 6 No 7 8 [Date] Inbound/ Outbound Provider/Recipient Internal/ External DRA - DSHS Provider/Entity Payment Information File Inbound CSHCN Internal Secure FTP Annually AHQP Eligibility File Acknowledgement EFA Inbound Other Internal Secure FTP Monthly Vision 21 AHQP Eligibility Response File ERF Inbound COBC External Secure FTP Monthly No Vision 21 Encounters Encounter Pharmacy Prior Authorization Vendor (PPAV) North STAR Encounter Inbound DSHS Internal Secure FTP Quarterly No Vision 21 Encounters Encounter Pharmacy Prior Authorization Vendor (PPAV) North STAR Enrollment Inbound DSHS Internal Secure FTP Quarterly EDW/BI DD&I Interface System Interface Subsystem Page Q-92 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 9 Maps to Existing Business Opportunity * No Vision 21 Encounters 10 No Vision 21 11 No 12 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Encounter Pharmacy Prior Authorization Vendor (PPAV) North STAR Hospital Inbound DSHS Internal Secure FTP Quarterly MAR/STAT HCS Waiver Recipients Inbound DADS Internal Annually Vision 21 AHQP HIPPS Data Match – SAVERR Data Inbound HHSC Internal Secure FTP Secure FTP No Vision 21 AHQP HIPPS Data Match – TWC Data Inbound HHSC Internal Secure FTP Quarterly 13 No Vision 21 AHQP Hospital Paid Claims File Inbound CSHCN Internal Not FTP (E-mail) Quarterly 14 No Vision 21 SURS Investigations List Inbound HHSC Internal Monthly 15 No Vision 21 AHQP Maximus Client File (P12) Inbound Maximus Internal Not FTP (e-mail) Secure FTP 16 No Vision 21 AHQP Maximus Provider File (P13) Inbound Maximus Internal Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-93 Confidential – Sensitive Procurement Information Media Frequency Quarterly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 17 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 18 No Vision 21 19 No 20 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Medical Transportation Expenses Inbound HHSC Internal Secure FTP Monthly MAR/STAT MTP TMTS Medical Appointment Interface Inbound HHSC Internal Secure FTP Weekly Vision 21 MAR/STAT MTP TMTS Report Interface Inbound HHSC Internal Secure FTP Weekly No Vision 21 AHQP Paid Claims File Inbound CSHCN Internal Quarterly 21 No Vision 21 MAR/STAT SAS Enrollment Inbound Inbound DADS Internal Not FTP (E-mail) Secure FTP 22 No Vision 21 Wellness Program TMWP Program Period Reconciliation Presumptive Eligibility File Inbound Inbound HHSC Internal Secure FTP Quarterly 23 No Vision 21 MAR/STAT TXHML Waiver Recipients Inbound DADS Internal Secure FTP Annually EDW/BI DD&I Interface System Interface Subsystem Page Q-94 Confidential – Sensitive Procurement Information Media Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 24 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 25 No Vision 21 26 No 27 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Action Code Description File - Actcode Inbound ACS-PCRA Internal Secure FTP Weekly Vendor Drug Vendor Drug Action Reason Code Description File Actreason Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Bureau Code Description File - Burecode Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Compound Code Description File - Compcode Inbound ACS-PCRA Internal Secure FTP Weekly Page Q-95 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 28 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 29 No Vision 21 30 No 31 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Compound Route Admn Code Description File - Routadmn Inbound ACS-PCRA Internal Secure FTP Weekly Vendor Drug Vendor Drug Cost Basis Code Description File - Costbas Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Cost Indicator Code Description File Costindi Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Daw Flag Code Description File - Dawflag Inbound ACS-PCRA Internal Secure FTP Weekly Page Q-96 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 32 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 33 No Vision 21 34 No 35 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug DEA Code Description File - Deacode Inbound ACS-PCRA Internal Secure FTP Weekly Vendor Drug Vendor Drug End Reason Code Description File Endreasn Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Exception Type Code Description File Excptype Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug HMO PLAN Code Description File HMOPLAN Inbound ACS-PCRA Internal Secure FTP Weekly Page Q-97 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 36 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 37 No Vision 21 38 No 39 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Indicator Description File - Drugindi Inbound ACS-PCRA Internal Secure FTP Weekly Vendor Drug Vendor Drug Prescriber Specialty Code Description File - Presspec Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug TX Clarity Code Description File - Rxclarfy Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Unlimited Flag Code Description File - Unldflg Inbound ACS-PCRA Internal Secure FTP Weekly Page Q-98 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 40 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 41 No Vision 21 42 No 43 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Weekly Claim File Inbound ACS-PCRA Internal Secure FTP Weekly Vendor Drug Vendor Drug Weekly Client Benefit Limit File Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Weekly Drug Unit History File Inbound ACS-PCRA Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Weekly NDC Coverage File Inbound ACS-PCRA Internal Secure FTP Weekly 44 No Vision 21 Vendor Drug Vendor Drug Weekly NDC File Inbound ACS-PCRA Internal Secure FTP Weekly 45 No Vision 21 Vendor Drug Vendor Drug Weekly Pharmacy Address File Inbound ACS-PCRA Internal Secure FTP Weekly EDW/BI DD&I Interface System Interface Subsystem Page Q-99 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 46 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 47 No Vision 21 48 No 49 50 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Weekly Pharmacy File Inbound ACS-PCRA Internal Secure FTP Weekly Vendor Drug Vendor Drug Weekly Prescriber Address File Inbound ACS-PCRA Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Weekly Prescriber File Inbound ACS-PCRA Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Weekly TX Therapeautic Class File Inbound ACS-PCRA Internal Secure FTP Weekly No Vision 21 Wellness Program Wellness Program Eligibility Return (WPER) File – Inbound from McKesson Inbound McKesson Internal Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-100 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 51 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 52 No Vision 21 53 No 54 55 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Wellness Program Monthly Presumptive Eligibility File – Inbound from HHSC-EA Inbound HHSC Internal Secure FTP Monthly MAR/STAT Active Medicaid Provider Interface Outbound DSHS Internal Secure FTP Monthly Vision 21 MAR/STAT American Recovery and Reinvestment Act )Extract File Outbound HHSC Internal Secure FTP Quarterly No Vision 21 IR Blue Ribbon ADDR Outbound HHSC-Hospital Reimbursement Internal Not FTP (CD) Annually No Vision 21 IR Blue Ribbon INRR521 Outbound HHSC-Hospital Reimbursement Internal Not FTP (CD) Annually EDW/BI DD&I Interface System Interface Subsystem Page Q-101 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 56 Maps to Existing Business Opportunity * No Vision 21 MSIS 57 No Vision 21 58 No 59 [Date] Inbound/ Outbound Provider/Recipient Internal/ External CHIP Perinatal Newborn MSIS Extract Outbound HHSC Internal Secure FTP Quarterly AHQP Claims History for Auto Assignment (P21) Outbound Maximus External Secure FTP Monthly Vision 21 CMS CMS - LTC MERP Data Outbound Other External Weekly No Vision 21 AHQP COBA Eligibility E01 Record Outbound COBC External Secure FTP Secure FTP 60 No Vision 21 CMS DADS Monthly extract from Vision 21 Outbound DADS Internal Secure FTP Monthly 61 No Vision 21 MAR/STAT DADS_Acute_Care_Claims.xls Outbound DADS Internal Secure FTP Monthly 62 No Vision 21 AHQP DADS_Master_Provider Outbound DADS Internal Monthly 63 No Vision 21 Vendor Drug DADS_NDC.xls Outbound DADS Internal 64 No Vision 21 Vendor Drug DADS_Pharmacy_Claims.xls Outbound DADS Internal Secure FTP Secure FTP Secure FTP EDW/BI DD&I Interface System Interface Subsystem Page Q-102 Confidential – Sensitive Procurement Information Media Frequency Monthly Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 65 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 66 No Vision 21 67 No 68 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Dental and Medical Checkups Update Outbound HHSC Internal Secure FTP Monthly IR Develop Blue Ribbon File Outbound HHSC-Hospital Reimbursement Internal Not FTP (CD) Annually Vision 21 AHQP DRG Claim Detail Extraction File Outbound Equiclaim External Secure FTP Monthly No Vision 21 AHQP DRG Claim Header Extraction File Outbound Equiclaim External Secure FTP Monthly 69 No Vision 21 AHQP DRG ICN Extraction File for OIG Outbound OIG Internal Secure FTP Monthly 70 No Vision 21 Encounters EHR Hospital Volumes Outbound CGI External Secure FTP Monthly 71 No Vision 21 Encounters EHR Panel Count Methodology Outbound CGI External Secure FTP Monthly 72 No Vision 21 Encounters EHR Visit Count Methodology Outbound CGI External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-103 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 73 Maps to Existing Business Opportunity * No Vision 21 History 74 No Vision 21 75 No 76 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Elig Recon Base files for MedSolutions Outbound Other External Secure FTP Monthly History Elig Recon Xref files for MedSolutions Outbound Other External Secure FTP Monthly Vision 21 Encounters Encounters - CFC Extract Outbound Other External Monthly No Vision 21 Encounters Encounters - DSHS Extract Outbound DSHS Internal Secure FTP Secure FTP 77 No Vision 21 Encounters Encounters - ICHP Extract 837 Outbound QM (ICHIP) External Secure FTP Monthly 78 No Vision 21 Encounters Encounters - ICHP Extract 837 DIM HDR PO Outbound QM (ICHIP) External Secure FTP Monthly 79 No Vision 21 Encounters Encounters - ICHP Extract 837 DIM HDR POA Outbound QM (ICHIP) External Secure FTP Monthly 80 No Vision 21 Encounters Encounters - ICHP Extract 837 DTL ADJDTN Outbound QM (ICHIP) External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-104 Confidential – Sensitive Procurement Information Media Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 81 Maps to Existing Business Opportunity * No Vision 21 Encounters 82 No Vision 21 83 No 84 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Encounters - ICHP Extract 837 DTL ADJMNT Outbound QM (ICHIP) External Secure FTP Monthly Encounters Encounters - ICHP Extract 837 DTL DNTL Outbound QM (ICHIP) External Secure FTP Monthly Vision 21 Encounters Encounters - ICHP Extract 837 DTL DRUG Outbound QM (ICHIP) External Secure FTP Monthly No Vision 21 Encounters Encounters - ICHP Extract 837 DTL EDT NO Outbound QM (ICHIP) External Secure FTP Monthly 85 No Vision 21 Encounters Encounters - ICHP Extract 837 DTL PRV Outbound QM (ICHIP) External Secure FTP Monthly 86 No Vision 21 Encounters Encounters - ICHP Extract 837 DTL SCNDRY Outbound QM (ICHIP) External Secure FTP Monthly 87 No Vision 21 Encounters Encounters - ICHP Extract 837 FCT DTL Outbound QM (ICHIP) External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-105 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 88 Maps to Existing Business Opportunity * No Vision 21 Encounters 89 No Vision 21 90 No 91 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Encounters - ICHP Extract 837 FCT HDR Outbound QM (ICHIP) External Secure FTP Monthly Encounters Encounters - ICHP Extract 837 FCT HDR INST Outbound QM (ICHIP) External Secure FTP Monthly Vision 21 Encounters Encounters - ICHP Extract 837 HDR ADJMNT Outbound QM (ICHIP) External Secure FTP Monthly No Vision 21 Encounters Encounters - ICHP Extract 837 HDR DIAG CONT Outbound QM (ICHIP) External Secure FTP Monthly 92 No Vision 21 Encounters Encounters - ICHP Extract 837 HDR DNTL Outbound QM (ICHIP) External Secure FTP Monthly 93 No Vision 21 Encounters Encounters - ICHP Extract 837 HDR EDT NO Outbound QM (ICHIP) External Secure FTP Monthly 94 No Vision 21 Encounters Encounters - ICHP Extract 837 HDR OTH SUB Outbound QM (ICHIP) External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-106 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 95 Maps to Existing Business Opportunity * No Vision 21 Encounters 96 No Vision 21 97 No 98 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Encounters - ICHP Extract 837 HDR PRV Outbound QM (ICHIP) External Secure FTP Monthly Encounters Encounters - ICHP Extract 837 HDR SBS CLNT Outbound QM (ICHIP) External Secure FTP Monthly Vision 21 Encounters Encounters - ICHP Extract 837 HDR SCNDRY Outbound QM (ICHIP) External Secure FTP Monthly No Vision 21 Encounters Encounters - ICHP Extract Member Outbound QM (ICHIP) External Secure FTP Monthly 99 No Vision 21 Encounters Encounters - ICHP Extract Provider Outbound QM (ICHIP) External Secure FTP Monthly 100 No Vision 21 Encounters Encounters - ICHP Extract Report Outbound QM (ICHIP) External Secure FTP Monthly 101 No Vision 21 MAR/STAT EOB Letter File Outbound Bowne External Monthly 102 No Vision 21 MFADS Fiscal Agent Public/Non Public Indicator File Outbound HHSC Internal Secure FTP Encrypted Hard Drive EDW/BI DD&I Interface System Interface Subsystem Page Q-107 Confidential – Sensitive Procurement Information Media Frequency Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 103 Maps to Existing Business Opportunity * No Vision 21 AHQP 104 No Vision 21 105 No 106 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Foster Care Health Passport Combined History Detail File Outbound General MCO Files External Secure FTP Weekly AHQP Foster Care Health Passport Combined History Header File Outbound General MCO Files External Secure FTP Weekly Vision 21 AHQP Foster Care Health Passport Combined Weekly Update Detail File Outbound General MCO Files External Secure FTP Weekly Vision 21 AHQP Foster Care Health Passport Combined Weekly Update Header File Outbound General MCO Files External Secure FTP Weekly Page Q-108 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 107 Maps to Existing Business Opportunity * No Vision 21 AHQP 108 No Vision 21 109 No 110 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Foster Care Health Passport LTC History Detail File Outbound General MCO Files External Secure FTP Weekly AHQP Foster Care Health Passport LTC History Header File Outbound General MCO Files External Secure FTP Weekly Vision 21 AHQP Foster Care Health Passport LTC Weekly Update Detail File Outbound General MCO Files External Secure FTP Weekly No Vision 21 AHQP Foster Care Health Passport LTC Weekly Update Header File Outbound General MCO Files External Secure FTP Weekly 111 No Vision 21 MAR/STAT HCS Acute Care / Pharmacy Claims Outbound DADS Internal Secure FTP Annually 112 No Vision 21 AHQP HIPP Data Match - HMS Outbound Other External Secure FTP Quarterly EDW/BI DD&I Interface System Interface Subsystem Page Q-109 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 113 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 114 No Vision 21 115 No 116 [Date] Inbound/ Outbound Provider/Recipient Internal/ External ICHP Program 100 Outbound QM (ICHIP) External MAR/STAT ICHP Program 200 Outbound QM (ICHIP) External Vision 21 AHQP Immunization Extract TDH/IMMTRAC Outbound DSHS Internal No Vision 21 AHQP Impact Pro Claim System Source Lookup Outbound Other 117 No Vision 21 AHQP Impact Pro Control Totals Extract Outbound 118 No Vision 21 AHQP Impact Pro Discharge Status (Institutional Patient Status) Lookup 119 No Vision 21 AHQP Impact Pro DRG Outlier Lookup EDW/BI DD&I Interface System Interface Subsystem Media Frequency Secure FTP Secure FTP Secure FTP Monthly External Secure FTP Monthly Other External Secure FTP Monthly Outbound Other External Secure FTP Monthly Outbound Other External Secure FTP Monthly Page Q-110 Confidential – Sensitive Procurement Information Monthly Weekly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 120 Maps to Existing Business Opportunity * No Vision 21 AHQP 121 No Vision 21 122 No 123 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Impact Pro Eligibility/Member Detail Extract Outbound Other External Secure FTP Monthly Encounters Impact Pro Encounter Place of Service Lookup Outbound Other External Secure FTP Monthly Vision 21 Encounters Impact Pro Medicaid Encounters Extract Outbound Other External Secure FTP Monthly No Vision 21 AHQP Impact Pro Medicaid Claims Extract (Acute Care) Outbound Other External Secure FTP Monthly 124 No Vision 21 AHQP Impact Pro Member Base Plan Lookup Outbound Other External Secure FTP Monthly 125 No Vision 21 AHQP Impact Pro Member County of Residence Look up Outbound Other External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-111 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 126 Maps to Existing Business Opportunity * No Vision 21 AHQP 127 No Vision 21 128 No 129 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Impact Pro Member Race Code Lookup Outbound Other External Secure FTP Monthly AHQP Impact Pro Member Region of Residence Look up Outbound Other External Secure FTP Monthly Vision 21 AHQP Impact Pro Member State Category of Assistance Lookup Outbound Other External Secure FTP Monthly No Vision 21 AHQP Impact Pro Member Type Program Look-up Outbound Other External Secure FTP Monthly 130 No Vision 21 Vendor Drug Impact Pro Pharmacy Claims Extract Outbound Other External Secure FTP Monthly 131 No Vision 21 AHQP Impact Pro Place of Service Lookup Outbound Other External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-112 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 132 Maps to Existing Business Opportunity * No Vision 21 Encounters 133 No Vision 21 134 No 135 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Impact Pro Plan Code Lookup Outbound Other External Secure FTP Monthly Encounters Impact Pro Provider Detail (Acute Care) Extract Outbound Other External Secure FTP Monthly Vision 21 Vendor Drug Impact Pro Provider Detail (Pharmacy) Extract Outbound Other External Secure FTP Monthly No Vision 21 AHQP Impact Pro Provider License Type Lookup Outbound Other External Secure FTP Monthly 136 No Vision 21 AHQP Impact Pro Provider Specialty Lookup Outbound Other External Secure FTP Monthly 137 No Vision 21 AHQP Impact Pro Provider Subspecialty Lookup Outbound Other External Secure FTP Monthly 138 No Vision 21 AHQP Impact Pro Provider Type Lookup Outbound Other External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-113 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 139 Maps to Existing Business Opportunity * No Vision 21 AHQP 140 No Vision 21 141 No 142 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Impact Pro Type of Bill Lookup Outbound Other External Secure FTP Monthly AHQP Impact Pro Type of Service Lookup Outbound Other External Secure FTP Monthly Vision 21 Encounters Inpatient Encounter Address File Outbound ACS-HealthCare Solutions Internal Not FTP (Database) Annually No Vision 21 Encounters Inpatient Encounter File Outbound ACS-HealthCare Solutions Internal Not FTP (Database) Annually 143 No Vision 21 Jcode JCode Billing Provider Extract Outbound ACS-PCRA Internal Secure FTP Quarterly 144 No Vision 21 Jcode JCode Claims Quarterly Update Outbound ACS-PCRA Internal Secure FTP Quarterly 145 No Vision 21 Jcode JCode PCN Extract Outbound ACS-PCRA Internal Quarterly 146 No Vision 21 Jcode JCode Performing Provider Extract Outbound ACS-PCRA Internal Secure FTP Secure FTP EDW/BI DD&I Interface System Interface Subsystem Page Q-114 Confidential – Sensitive Procurement Information Media Frequency Quarterly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 147 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 148 No Vision 21 149 No 150 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Limited Services Payment Outbound HHSC Internal Secure FTP Monthly MAR/STAT Medicare Buy-In Candidates Interface File Outbound HHSC Internal Secure FTP Monthly Vision 21 AHQP MEHIS split PCN Outbound HP-MEHIS Internal Weekly No Vision 21 MAR/STAT MHMR STAT File Outbound MHMR Internal 151 No Vision 21 AHQP MODIFIER-AMBULANCE Outbound HHSC Internal Secure FTP Secure FTP Encrypted Hard Drive 152 No Vision 21 AHQP MSIS Claim IP - Acute Care (Traditional FFS) Outbound HHSC Internal Secure FTP Quarterly 153 No Vision 21 AHQP MSIS Claim LT - Acute Care (Traditional Psych) Outbound HHSC Internal Secure FTP Quarterly 154 No Vision 21 AHQP MSIS Claim LT - CMS Outbound HHSC Internal Secure FTP Quarterly EDW/BI DD&I Interface System Interface Subsystem Page Q-115 Confidential – Sensitive Procurement Information Media Frequency Monthly Monthly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 155 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 156 No Vision 21 157 No 158 [Date] Inbound/ Outbound Provider/Recipient Internal/ External MSIS Claim MT - Medical Transportation Outbound HHSC Internal Secure FTP Quarterly AHQP MSIS Claim OT - Acute Care (Traditional FFS) Outbound HHSC Internal Secure FTP Quarterly Vision 21 AHQP MSIS Claim OT - CMS Outbound HHSC Internal Quarterly No Vision 21 Encounters MSIS Encounters IP Outbound HHSC Internal Secure FTP Secure FTP 159 No Vision 21 Encounters MSIS Encounters LT Outbound HHSC Internal Secure FTP Quarterly 160 No Vision 21 Encounters MSIS Encounters OT Outbound HHSC Internal Secure FTP Quarterly 161 No Vision 21 AHQP MTP Matching Report Interface Outbound HHSC Internal Secure FTP Quarterly 162 No Vision 21 MAR/STAT MTP TMTS Medical Appointment Errors Interface Outbound HHSC Internal Secure FTP Weekly EDW/BI DD&I Interface System Interface Subsystem Page Q-116 Confidential – Sensitive Procurement Information Media Frequency Quarterly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 163 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 164 No Vision 21 165 No 166 [Date] Inbound/ Outbound Provider/Recipient Internal/ External MTP TMTS Report Errors Interface Outbound HHSC Internal Secure FTP Weekly MAR/STAT Non-Encounter STAT File CFC Outbound Other External Secure FTP Monthly Vision 21 MAR/STAT Non-Refugee Denied STAT File (Discontinued as of 200808-31) Outbound DADS Internal Tape Monthly No Vision 21 AHQP PGM_EXPLANATION Outbound HHSC Internal Encrypted Hard Drive Monthly 167 No Vision 21 AHQP Pregnancy Termination Extract to DHS (TP40) Outbound EA-TIERS Internal Secure FTP Weekly 168 No Vision 21 MAR/STAT Pregnant Teens Interface Outbound Maximus Internal Secure FTP Monthly 169 No Vision 21 AHQP Recover HCFA Matching Funds Outbound CSHCN Internal Not FTP (E-mail) Quarterly EDW/BI DD&I Interface System Interface Subsystem Page Q-117 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 170 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 171 No Vision 21 172 No 173 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Media Refugee Denied STAT File (Discontinued as of 2008-0831) Outbound DADS Internal Encrypted Hard Drive Monthly MAR/STAT Refugee Paid STAT File (Discontinued as of 2008-0831) Outbound DADS Internal Encrypted Hard Drive Monthly Vision 21 AHQP RLS (Record Locator Service to MEHIS) Outbound HP-MEHIS Internal Secure FTP Daily No Vision 21 Encounters STAR Outbound Health Information Designs (HID) External Secure FTP Monthly 174 No Vision 21 Encounters STAR Health Outbound Health Information Designs (HID) External Secure FTP Monthly 175 No Vision 21 Encounters STAR Health Encounters Outbound ACS-Heritage Internal Secure FTP Monthly 176 No Vision 21 Encounters STAR MCO Encounter Outbound ACS-Heritage Internal Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-118 Confidential – Sensitive Procurement Information Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 177 Maps to Existing Business Opportunity * No Vision 21 Encounters 178 No Vision 21 179 No 180 [Date] Inbound/ Outbound Provider/Recipient Internal/ External STAR Plus Outbound Health Information Designs (HID) External Secure FTP Monthly Encounters STAR Plus Encounter Outbound ACS-Heritage Internal Monthly Vision 21 MAR/STAT STAT File to CSHCN Outbound DSHS Internal No Vision 21 TPR/TARS/Tort SURS 121 CD-ROM Extract Outbound HHSC Internal Secure FTP Secure FTP Not FTP (Database) 181 No Vision 21 AHQP THSteps Dental Checkup Extract (HISR302A) Outbound DSHS Internal Secure FTP Annually 182 No Vision 21 AHQP THSteps Dental Provider Participation Extract - Annual (HISR301A) Outbound DSHS Internal Secure FTP Annually 183 No Vision 21 AHQP THSteps Dental Provider Participation Extract (HISR301Q) Outbound DSHS Internal Secure FTP Quarterly EDW/BI DD&I Interface System Interface Subsystem Page Q-119 Confidential – Sensitive Procurement Information Media Frequency Monthly Annually Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 184 Maps to Existing Business Opportunity * No Vision 21 History 185 No Vision 21 186 No Vision 21 EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External THSteps Medical Service Utilization Extract (Acute Care Plus Encounters) for FFY (HISR303) Outbound DSHS Internal Secure FTP Annually History THSteps Medical Service Utilization Extract (Acute Care Plus Encounters) for SFY (HISR303) Outbound DSHS Internal Secure FTP Monthly History THSteps Medical Service Utilization Extract for FFY (HISR303) Outbound DSHS Internal Secure FTP Annually Page Q-120 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 187 Maps to Existing Business Opportunity * No Vision 21 History 188 No Vision 21 189 No 190 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External THSteps Medical Service Utilization Extract for SFY (HISR303) Outbound DSHS Internal Secure FTP Monthly MAR/STAT THSteps STAT File Outbound DSHS Internal Monthly Vision 21 Wellness Program TMWP Program Period Reconciliation Acute Care Claim History Detail File Outbound McKesson External Secure FTP Secure FTP Vision 21 Wellness Program TMWP Program Period Reconciliation Acute Care Claim History Detail File Outbound Mercer External Secure FTP Quarterly Page Q-121 Confidential – Sensitive Procurement Information Media Frequency Quarterly Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 191 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 192 No Vision 21 193 No 194 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External TMWP Program Period Reconciliation Acute Care Claim History Header File Outbound McKesson External Secure FTP Quarterly Wellness Program TMWP Program Period Reconciliation Acute Care Claim History Header File Outbound Mercer External Secure FTP Quarterly Vision 21 Wellness Program TMWP Program Period Reconciliation Extract Summary Report Outbound McKesson External Secure FTP Quarterly Vision 21 Wellness Program TMWP Program Period Reconciliation Extract Summary Report Outbound Mercer External Secure FTP Quarterly Page Q-122 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 195 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 196 No Vision 21 197 No Vision 21 EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External TMWP Program Period Reconciliation Long Term Care Claim History Detail File Outbound McKesson External Secure FTP Quarterly Wellness Program TMWP Program Period Reconciliation Long Term Care Claim History Detail File Outbound Mercer External Secure FTP Quarterly Wellness Program TMWP Program Period Reconciliation Long Term Care Claim History Header File Outbound McKesson External Secure FTP Quarterly Page Q-123 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 198 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 199 No Vision 21 200 No Vision 21 EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External TMWP Program Period Reconciliation Long Term Care Claim History Header File Outbound Mercer External Secure FTP Quarterly Wellness Program TMWP Program Period Reconciliation PCRA Claim History File Outbound McKesson External Secure FTP Quarterly Wellness Program TMWP Program Period Reconciliation PCRA Claim History File Outbound Mercer External Secure FTP Quarterly Page Q-124 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 201 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 202 No Vision 21 203 No 204 205 [Date] Inbound/ Outbound Provider/Recipient Internal/ External TMWP Program Period Reconciliation Presumptive Eligibility File Outbound Outbound McKesson External Secure FTP Quarterly Wellness Program TMWP Program Period Reconciliation Presumptive Eligibility File Outbound Outbound Mercer External Secure FTP Quarterly Vision 21 Encounters TX Northstar Eligibility Outbound ACS-Heritage Internal Secure FTP Quarterly No Vision 21 Encounters TX Northstar Encounter Outbound ACS-Heritage Internal Secure FTP Quarterly No Vision 21 Encounters TX Northstar Encounter HID Outbound Health Information Designs (HID) External Secure FTP Quarterly EDW/BI DD&I Interface System Interface Subsystem Page Q-125 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 206 Maps to Existing Business Opportunity * No Vision 21 Encounters 207 No Vision 21 208 No 209 [Date] Inbound/ Outbound Provider/Recipient Internal/ External TX Northstar Enrollment HID Outbound Health Information Designs (HID) External Secure FTP Quarterly Encounters TX Northstar Hospital Outbound ACS-Heritage Internal Secure FTP Quarterly Vision 21 Encounters TX Northstar Hospital HID Outbound Health Information Designs (HID) External Secure FTP Quarterly No Vision 21 MAR/STAT TXHML Acute Care Pharmacy Claims Outbound DADS Internal Secure FTP Annually 210 No Vision 21 MAR/STAT UT San Antonio Acute Care Data Interface Outbound UT-San Antonio External Secure FTP Monthly 211 No Vision 21 MAR/STAT UT San Antonio Long Term Services and Support Data Interface Outbound UT-San Antonio External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-126 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 212 Maps to Existing Business Opportunity * No Vision 21 MAR/STAT 213 No Vision 21 214 No 215 216 [Date] Inbound/ Outbound Provider/Recipient Internal/ External UT San Antonio Pharmacy Data Interface File Outbound UT-San Antonio External Secure FTP Monthly MAR/STAT V21 Expendtiure Report for SSLC Acute Care Claims Outbound DADS-LTC Internal Secure FTP Monthly Vision 21 Vendor Drug Vendor Drug Pharmacy Claims Error log Outbound HHSC Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Pharmacy Claims to be Researched log Outbound HHSC Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Smart PA Acute Care Claims Hdr File Outbound Other Internal Secure FTP Weekly EDW/BI DD&I Interface System Interface Subsystem Page Q-127 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 217 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 218 No Vision 21 219 No 220 221 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Smart PA Acute Care Detail File Outbound Other Internal Secure FTP Weekly Vendor Drug Vendor Drug Smart PA Acute Care Provider File Outbound Other Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Smart PA Acute Care Purge File Outbound Other Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Smart PA Acute Care Reference Diagnosis Outbound Other Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Smart PA Acute Care Reference Procedure Code File Outbound Other Internal Secure FTP Weekly EDW/BI DD&I Interface System Interface Subsystem Page Q-128 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 222 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 223 No Vision 21 224 No 225 226 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Smart PA Extract Summary Report Outbound Other Internal Secure FTP Weekly Vendor Drug Vendor Drug Smart PA Long Term Care (CMS) Claim Detail Outbound Other Internal Secure FTP Weekly Vision 21 Vendor Drug Vendor Drug Smart PA Long Term Care (CMS) Claim Header Outbound Other Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Smart PA Long Term Care (CMS) Provider Outbound Other Internal Secure FTP Weekly No Vision 21 Vendor Drug Vendor Drug Smart PA Long Term Care National Procedure Code File Outbound Other Internal Secure FTP Weekly EDW/BI DD&I Interface System Interface Subsystem Page Q-129 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 227 Maps to Existing Business Opportunity * No Vision 21 Vendor Drug 228 No Vision 21 229 No 230 231 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Vendor Drug Smart PA Long Term Care Purge Claim File Outbound Other Internal Secure FTP Weekly Vendor Drug Vendor Drug Smart PA TPI/NPI Master Crosswalk Outbound Other Internal Secure FTP Weekly Vision 21 AHQP Vendor Drug Weekly License Number/TPI/NPI Crosswalk Outbound HHSC Internal Secure FTP Weekly No Vision 21 Wellness Program Wellness Program 36-Month PCRA Claim Detail Outbound McKesson External Secure FTP Monthly No Vision 21 Wellness Program Wellness Program Acute Care 36-Month Claim History Detail File Outbound McKesson External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-130 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 232 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 233 No Vision 21 234 No 235 236 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Wellness Program Acute Care 36-Month Claim History Header File Outbound McKesson External Secure FTP Monthly Wellness Program Wellness Program Acute Care 36-Month Purge File Outbound McKesson External Secure FTP Monthly Vision 21 Wellness Program Wellness Program Acute Care Claim Detail Update File Outbound McKesson External Secure FTP Monthly No Vision 21 Wellness Program Wellness Program Acute Care Claim Header Update File Outbound McKesson External Secure FTP Monthly No Vision 21 Wellness Program Wellness Program Acute Care Monthly Purge File Outbound McKesson External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-131 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 237 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 238 No Vision 21 239 No 240 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Wellness Program Acute Care Provider File Outbound McKesson External Secure FTP Monthly Wellness Program Wellness Program Eligibility Return (WPER) File Outbound to HHSC-EA Outbound HHSC Internal Secure FTP Monthly Vision 21 Wellness Program Wellness Program Extract Summary Report Outbound McKesson External Secure FTP Monthly Vision 21 Wellness Program Wellness Program Long Term Care 36-Month Claim History Detail File Outbound McKesson External Secure FTP Monthly Page Q-132 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 241 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 242 No Vision 21 243 No 244 No EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Wellness Program Long Term Care 36-Month Claim History Header File Outbound McKesson External Secure FTP Monthly Wellness Program Wellness Program Long Term Care Claim Detail Update File Outbound McKesson External Secure FTP Monthly Vision 21 Wellness Program Wellness Program Long Term Care Claim History Header Update File Outbound McKesson External Secure FTP Monthly Vision 21 Wellness Program Wellness Program Long Term Care Monthly Purge File Outbound McKesson External Secure FTP Monthly Page Q-133 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 245 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 246 No Vision 21 247 No 248 249 [Date] Inbound/ Outbound Provider/Recipient Internal/ External Wellness Program Monthly CMS (LTC) Provider Outbound McKesson External Secure FTP Monthly Wellness Program Wellness Program Monthly PCRA Claim Detail Outbound McKesson External Secure FTP Monthly Vision 21 Wellness Program Wellness Program Monthly Presumptive Eligibility File – Outbound to McKesson Outbound McKesson External Secure FTP Monthly No Vision 21 Wellness Program Wellness Program PCRA 36Month Purge File Outbound McKesson External Secure FTP Monthly No Vision 21 Wellness Program Wellness Program PCRA Monthly Purge File Outbound McKesson External Secure FTP Monthly EDW/BI DD&I Interface System Interface Subsystem Page Q-134 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Datamart Sub Datamart 250 Maps to Existing Business Opportunity * No Vision 21 Wellness Program 251 No Vision 21 252 No Vision 21 EDW/BI DD&I [Date] Interface System Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Wellness Program TPI / NPI Master Crosswalk Outbound McKesson External Secure FTP Monthly AHQP TDH-CSHCN Input File Inbound CSHCN Internal Not FTP (E-mail) Quarterly Vendor Drug Vendor Drug Program Type Code Description File Progtype Inbound ACS-PCRA Internal Secure FTP Weekly Page Q-135 Confidential – Sensitive Procurement Information Media Frequency Texas Health and Human Services Commission RFP No. 529-13-0018 [Date] TIERS Data Mart Interfaces Ref # 1 Maps to Existing Business Opportunity * No 2 No 3 No 4 No TIERS DM N/A PEBLES HR Organization Data Inbound PEBLES HR Internal Secure FTP Daily MonSat N/A 5 No TIERS DM N/A Disposition Activity File (Timeliness)This file contains all the dispositions that occurred within that cutoff. Timeliness is computed for each record Outbound SDS Internal Secure FTP Monthly File Format Pipe Delimited Full/Incremental Data Incremental Typical extract size(rows) 3213 EDW/BI DD&I Datamart Sub Datamart TIERS DM TIERS DM TIERS DM N/A Inbound/ Outbound Provider/Recipient Internal/ External Media Frequency Client Eligibility Workflow Inbound TIERS Internal ETL N/A Inbound TLM Internal ETL N/A OES Organization and Employee Information Inbound HHSAS (Access HR) Internal Secure FTP Daily MonSat Daily MonSat Daily MonSat N/A Interface System Interface Subsystem Page Q-136 Confidential – Sensitive Procurement Information Sizing** N/A 5MB Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # Maps to Existing Business Opportunity * Datamart Sub Datamart 6 No TIERS DM N/A EDW/BI DD&I Interface System CBO Activity File -This file contains the CBO activity. Includes pending and disposition data that occurred within that cutoff. [Date] Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Media Frequency Outbound SDS Internal Secure FTP Monthly Page Q-137 Confidential – Sensitive Procurement Information Sizing** File Format Pipe Delimited Full/Incremental Data Incremental Typical extract size(rows) 731935 Texas Health and Human Services Commission RFP No. 529-13-0018 Ref # 7 Maps to Existing Business Opportunity * No EDW/BI DD&I Datamart Sub Datamart TIERS DM N/A Interface System Caseload Activity File(Timeliness) -This file contains all the Caseload activity that are found to be delinquent as of the day of that cutoff. [Date] Interface Subsystem Inbound/ Outbound Provider/Recipient Internal/ External Media Frequency Outbound SDS Internal Secure FTP Monthly Page Q-138 Confidential – Sensitive Procurement Information Sizing** File Format Pipe Delimited Full/Incremental Data Incremental Typical extract size(rows) 3271
