Medicaid Enterprise Systems – Claims Processing and Management Services Module

The Medicaid Enterprise Systems Claims Processing and Management Services Module is a cooperative contract portfolio led by the state of Montana under solicitation NASPO-ADT-122. This initiative provides State Medicaid agencies with a mechanized claims processing and information retrieval system as required by the Social Security Act and Federal Code 42 CFR 433.111. Delivered as a Software as a Service solution, the portfolio supports the receipt, adjudication, editing, pricing, and payment of healthcare program claims through modern, flexible, and configurable systems. The core service focuses on claims adjudication, with additional optional modules available for financial management, call center operations, and federal reporting. The master agreements within this portfolio were established following a competitive RFP process completed in 2020, with awards publicly posted starting September 2, 2020. The contract term runs from January 4, 2021, through January 3, 2028, with the possibility of three one-year renewals, extending the total potential term to ten years. The procurement process involved a rigorous multi-step evaluation including technical proposals, product demonstrations, and cost proposal scoring. This cooperative arrangement allows participating states to leverage qualified suppliers to ensure federal compliance and operational efficiency in managing their Medicaid healthcare programs.