RFP Sourcing Event - Provider Data Management_Credentialing Verification Office RFP

The Purpose of this Request for Proposal (RFP) is the for the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB or Department), to solicit offers for the acquisition for the Provider Data Management Credentialing Verification Organization (PDM/CVO). Medicaid Integrated Modular Solution (MIMS) NCDHHS is replacing the Department’s Medicaid Management Information System (MMIS) with a Medicaid Enterprise System (MES), also referred to as the Medicaid Integrated Modular Solution (MIMS). MIMS will be implemented through a multi-phase initiative, the MMIS Replacement Project. The MMIS Replacement Project will implement a series of interrelated modules. These modules will have functionality designated by the Centers for Medicare and Medicaid (CMS) in support of obtaining compliance with Medicaid Information Technology Architecture (MITA) 3.0 Framework and CMS certification for each module. The future PDM/CVO solution is envisioned as a centralized Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution that will support the Agency’s provider data management functions including data intake, data management, enrollment, credentialing, data sharing and data archiving throughout the provider life cycle. The solution will also meet National Committee for Quality Assurance (NCQA) standards and enhance provider credentialing through centralized CVO features that include a Credentialing Committee and delegated enrollment and credentialing. The PDM/CVO solution will consist of the below high-level items: Consolidate all provider data to reduce administrative redundancy for providers. Simplify enrollment, data maintenance and revalidation processes. Facilitate centralized credentialing on behalf of NCDHHS payers and health plans. Potentially mitigate reimbursement errors caused by outdated provider data. Allow for delegated enrollment and credentialing. Aligning North Carolina’s credentialing process with NCQA standards. Establish a representative centralized Credentialing Committee with representatives from NCDHHS payers and health plans. The NC MIMS system will modernize and transform North Carolina Medicaid and its sister divisions, including the Division of Mental Health (DMH) and Division of Public Health (DPH). NC MIMS will improve the Provider and Medicaid beneficiary experience across the enterprise.