Medicaid Enterprise Systems – Claims Processing and Management Services Module

The Medicaid Enterprise Systems – Claims Processing and Management Services Module under solicitation NASPO-ADT-122 provides state Medicaid agencies with a compliant, scalable, and modern system for processing healthcare claims in accordance with federal requirements under section 1903(a)(3) of the Social Security Act and 42 CFR 433.111. This cooperative procurement vehicle, managed by NASPO ValuePoint and led by the state of Montana, offers pre-vetted suppliers delivering Software as a Service solutions that handle the full lifecycle of Medicaid claims including receipt, adjudication, editing, pricing, and payment. The agreement ensures states can access flexible, configurable technology that adapts to evolving healthcare needs without the burden of custom development or long-term infrastructure investments. The contract is effective through January 3, 2028, and supports all participating states in meeting federal MMIS obligations through a shared, cost-efficient model. Key stakeholders include Nolan Harris, Lead State Administrator for Montana, and NASPO representatives Tia Corbett and Angie Negley, who provide program and portfolio oversight. The agreement enables statewide implementation of secure, interoperable systems that improve program integrity, reduce administrative costs, and enhance data accuracy across Medicaid operations. Participation is open to all states seeking a streamlined path to modernize their claims processing infrastructure under a trusted, multi-state cooperative structure.