Upcoming Procurements

Estimated Release Dates provided are based on calendar year and are subject to change.

Provider Services Solution

  • Procurement Number:  31865-00652
  • Projected Release Date: 4th Quarter 2024
  • Summary:

TennCare seeks to select a contractor that will successfully implement a Provider Services Solution, with optional services for Enrollment Specialists, Call Center Support, and Site Visit Support for the State. The Solution will serve as the system of record for TennCare Provider Registration/Enrollment data, and should meet the following at a minimum:​ ​

- Use automated screening and monitoring processes and tools to verify provider enrollment and eligibility based on Federal requirements contained in 42 CFR 455.436

- Meets the requirements set forth in Tenn. Code Ann. (TCA) § 56-7-1009 regarding health care provider credentialing applications from the Council on Affordable Quality Healthcare (CAQH)

- Improve provider data quality through seamless integration with CAQH ProView

- Reduce the administrative burden of Medicaid providers

- Improve provider-related business process efficiencies and data accuracy using configurable business rules, modernized technologies and practices​

- Improve the provider data reporting capabilities between TennCare and CMS​

- Reduce the manual effort and administrative burden to TennCare through integration, automation​, and reporting

- Successfully attain CMS Certification

EMPLOYMENT AND COMMUNITY FIRST (ECF) CHOICES TRAINING & TECHNICAL ASSISTANCE, AND PRE-ADIMISSION SCREENING AND RESIDENT REVIEW (PASRR) PROCESSES AND SERVICES (REISSUE)

  • Procurement Number: 31865-00650
  • Release Date: February 2, 2024
  • Summary:

The State of Tennessee, Division of TennCare (TennCare), Long Term Services and Supports (LTSS) is seeking a contractor to provide Employment and Community First (ECF) CHOICES Training and Technical Assistance, Pre-Admission Screening and Resident Review (PASRR) processes, services related to medical or Level of Care (LOC) eligibility assessments and appeals for Long-Term Services and Supports (LTSS), , and Supports Intensity Scale™ (SIS™) assessments. These services will need to incorporate the following:

- Training and Technical Assistance related to the following: training and certifying staff to perform the Maladaptive Behavior Assessment component of the Inventory for Client and Agency Planning (ICAP), Life Skills Assessment training, development of an electronic tool to calculate the Maladaptive Behavior Index Score, processes for conducting post-scoring audits of Maladaptive Behavior Assessment, and targeted training and technical assistance to improve assessment accuracy and performance. 

- Pre-Admission Screening and Resident Review (PASRR) process: Level I assessment, Level II assessment, and appeals.

- Medical or Level of Care (LOC) eligibility assessments and appeals for Long-Term Services and Supports (LTSS) programs.

QA Testing Services

  • Procurement Number: 31865-00651
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

TennCare seeks to select a Contractor to centralize User-Acceptance (UAT) testing services in support of TennCare business units. The selected Contractor will support and oversee user acceptance testing (UAT) activities across TennCare MMIS modules and business applications. The Contractor will be responsible for providing testing resources and services to support quality assurance activities for the release of new applications/modules and enhancements to operational applications/modules that will include test script creation and review, test execution, incident reporting and defect re-testing, and test automation support for UAT and Operation & Maintenance phases. The Contractor is expected to provide appropriately skilled and experienced testing resources (i.e., Manual/Functional testers, UAT Script Development Leads/Business Analysts, Technical Testers (ETL/Batch testing), and potentially Automation Engineers) for each applicable business unit with the goal of improving testing rigor and the overall quality of work completed. This transformation to a centralized enterprise capability will serve to modernize the future of TennCare User Acceptance Testing (UAT) by improving the quality of existing manual UAT collateral, and with a strong emphasis on minimizing manual regression testing and increasing test automation.

TENNESSEE ELIGIBILITY DETERMINATION SYSTEM (TEDS)

  • Procurement Number: 31865-00648
  • Projected Release Date: 3rd Quarter 2024
  • Summary:

TennCare seeks a Contractor with the qualifications and experience necessary to assume, operate, and enhance TennCare’s Tennessee Eligibility Determination System (TEDS). The TEDS platform includes data collection, application registration, eligibility determination and appeals, and correspondence functionality for applicants and members to Tennessee Medicaid and/or Children’s Health Insurance Program (CHIP), Pre-Admission Evaluations and Referrals for Long Term Services and Support (PERLSS), and Medical Appeals Tracking System (MATS) for medical services. It also includes member-facing and partner-facing portals and a mobile application.

TEDS is the TennCare solution that establishes and maintains eligibility for Medicaid and CHIP.

PERLSS is the TennCare Long-Term Services and Supports (LTSS) solution that manages and tracks medical evaluations to determine enrollment in several Long-Term Services and Supports programs.

MATS is the TennCare Medical Appeal Tracking System used to manage Member medical services appeals
 

PREPAID INPAITIENT HEALTH PLAN (PIHP)

  • Procurement Number: 31865-00637
  • Release Date: November 7, 2023
  • Summary:

TennCare seeks to select a contractor to maintain a statewide administrative services only contract for medical services and care management. Contractor will be required to maintain a statewide network of providers across all areas of medical and behavioral health services and pay claims and manage care for the population that is enrolled with this contractor.

Dental Benefits Management (DBM) Program

  • Procurement Number: 31865-00636
  • Release Date: January 3, 2024
  • Summary:

The State seeks to identify a Contractor for the statewide provision of Dental Benefits Management (DBM) services for five (5) separate State DBM Programs (collectively referred to as the “State DBM Programs”), which include:

1) TennCare Children’s DBM Program, which is part of the TennCare Program, and administers dental services to approximately 900,000 eligible enrollees under age 21;

2) TennCare Employment and Community First (ECF) CHOICES Program, which administers covered adult dental benefits to approximately 5,500 eligible adults age 21 and older who have an intellectual or developmental disability and are enrolled in TennCare ECF CHOICES;

3) TennCare Adults with Intellectual or Developmental Disabilities Dental Program, which administers covered dental benefits to approximately 6,500 adults age 21 and older with Intellectual or Developmental Disabilities (IDD) that are enrolled in the Section 1915(c) Home and Community Based Services (HCBS) Waiver (TennCare 1915(c) Dental Program);

4) TennCare Adult Dental DBM Program, which administers covered adult dental benefits to approximately 650,000 eligible adults age 21 and older who are TennCare members;

5) CoverKids DBM Program, which is part of the federal Children’s Health Insurance Program (CHIP), referred to in Tennessee as the CoverKids Program (CoverKids) which is a self-funded health plan providing certain dental benefits to approximately 40,000 eligible enrollees under age 19 enrolled in CoverKids medical coverage.

Bridge Conferencing and Recording Service

  • Procurement Number: 31865-00642
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

In accordance with state and federal laws, TennCare conducts administrative hearings regarding eligibility determinations and adverse actions. These hearings are overseen by Administrative Judges, are typically conducted by phone, and must always be recorded and preserved. TennCare seeks a contractor to provide bridge conferencing services through which such hearings may be conducted, recorded, and archived.

SOC Managed Services

  • Procurement Number: 31865-00641
  • Projected Release Date: 1st quarter 2024
  • Summary:

TennCare seeks to select a Contractor to provide Managed Security Services (MSS) on a 24x7x365 basis.  The Contractor will perform continuous monitoring, analysis and reporting of security alerts and event information from approved security feeds, create and manage custom detection content for TennCare’s SIEM platform, and collect, process, and analyze threat intelligence data to determine if TennCare’s systems are affected with the latest cyber threats.

Asset Verification System

  • Procurement Number: 31865-00645
  • Projected Release Date: 1st Quarter 2024
  • Summary:

TennCare seeks to select a contractor to provide electronic verification of resources to be used in the TennCare application and renewal processes. Contractor will be required to maintain a national link to financial institutions to provide near real time verification and identification of assets.

Member Services Contact Center

  • Procurement Number: 31865-00649
  • Projected Release Date: 1st Quarter 2024
  • Summary:

TennCare seeks a Contractor that shall provide the staff, the facility, and Technology of the management of a States TennCare Member Services Contact Center furnished Contact Center solution (hereinafter referred to as “TennCare Connect” or “Contact Center” to support TennCare and Children’s Health Insurance Program (CHIP) eligibility services for individuals seeking to obtain and maintain eligibility for TennCare and CHIP. The Division of TennCare (“TennCare”) is the single state agency designated by the State and the Centers for Medicare and Medicaid Services (CMS) to administer the federal Medicaid program (known in Tennessee as “TennCare”) pursuant to Title XIX of the Social Security Act (42 U.S.C § 1396 et seq.) and the Section 1115 research and demonstration waiver granted to the State and any successor programs by CMS. TennCare also administers the federal Social Security Act Title XXI Children’s Health Insurance Program (CHIP), known as “CoverKids” in Tennessee, which provides certain self-funded health plan services to eligible children under age nineteen (19), including unborn children who are covered from conception to birth.

Value -Based Payment (VBP) Program Consulting Services

  • Procurement Number: 31865-00647
  • Projected Release Date: 2nd Quarter 2024
  • Summary:

TennCare seeks to select a contractor that will help TennCare develop and implement a coordinated value-based payment (VBP) strategy that advances accountability for quality and total cost of care that aims to meaningfully improve the health and health care experience of TennCare members. The VBP strategy will include the evaluation of existing TennCare VBP programs, designing and implementing enhancements to existing TennCare VBP programs, and the exploration of expanding the TennCare VBP portfolio.

If you are interested in any of the above procurements and would like further information, please email matt.brimm@tn.gov with a cc to Donovan.Morgan2@tn.gov and mitchell.d.plumer@tn.gov.

*POSTED – Central Procurement Office (CPO) Request for Proposals (RFP) Opportunities

http://tn.gov/generalservices/procurement/central-procurement-office--cpo-/supplier-information/request-for-proposals--rfp--opportunities1.html