Upcoming Procurements

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

Fraud Waste & Abuse (FWA)

Procurement Number: 31865-00675
Release Date: 3^rd Quarter 2027
Summary:

TennCare is seeking a comprehensive solution that supports end-to-end case management and tracking for fraud, waste, and abuse investigations. In addition, the State requires advanced fraud analytics capabilities designed to strengthen both post-pay and pre-pay FWA prevention and detection. This solution should enhance operational efficiency, improve visibility into case activity, and enable proactive identification of potential risks across managed care organizations.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Fraud Waste and Abuse, associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Nursing Facility Quality Improvement in Long-Term Services and Supports (NF QuILTSS)

Procurement Number: 31865-00674
Release Date: 2^nd Quarter 2027
Summary:

The State of Tennessee, through TennCare’s Long‑Term Services and Supports (LTSS) Division, is seeking a Contractor to administer standardized satisfaction surveys for Medicaid‑participating nursing facilities statewide. These surveys—completed by residents, family members or caregivers, and facility staff—support the Nursing Facility Value‑Based Purchasing (VBP) Program and TennCare’s quality oversight responsibilities.

The Contractor will provide a complete, end‑to‑end solution that includes validated survey instruments, compliant sampling and secure distribution, confidential response collection, data processing and analytics, and provider‑level and statewide reporting.

The Contractor must implement an engagement and communications strategy with multi‑channel outreach, accessible promotional materials, and content designed to be understandable for individuals with varying cognitive and literacy levels. Requirements also include structured training for facility staff, ongoing technical assistance, and virtual town‑hall sessions to support participation across all required survey populations.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation NF QuILTSS, associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Community Health Worker (CHW) Infrastructure Project

Procurement Number: RFA 31865-00020
Projected Release Date: 4th Quarter 2026
Summary:

TennCare will soon release a Request for Applications (RFA) for the Community Health Worker (CHW) Infrastructure Project. This funding opportunity will support health care provider organizations that employ, or intend to employ, Community Health Workers in building sustainable program infrastructure aligned with CHW program standards. This initiative is part of Tennessee’s Rural Health Transformation (RHT) efforts and focuses on strengthening CHW programs that serve TennCare members, with priority consideration for organizations serving individuals residing in rural communities. The RFA will outline eligibility criteria, allowable expenses, funding tiers, required deliverables, and the technical assistance supports included in this opportunity. Initial funding will be awarded for the first year of the grant period, and additional years of funding may be available based on performance, progress toward required milestones, and availability of funds. All awarded Grantees will be required to complete specified deliverables and reporting requirements as outlined in the Grant Contract.

The full RFA, including attachments and the detailed Schedule of Events, will be posted on the Upcoming

Procurements webpage once available. Questions regarding this procurement must be submitted in writing during the designated Questions & Comments period after the RFA is issued

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Nursing Facility Reimbursement Rate Structure

Procurement Number: RFQ 31865-00672
Projected Release Date: 4^th Quarter 2026
Summary:

The Department of Finance and Administration, Division of TennCare, the State of Tennessee’s Medicaid Program (TennCare), is soliciting proposals for a Contractor to assist the State in designing and maintaining a reimbursement rate structure for nursing facilities in Tennessee with Medicaid patients that are paid a daily per diem for each patient. The per diem consists of several components, including but not limited to: direct care, indirect care, fair rental value, acuity, quality, and a tax pass-through. The Contractor will also conduct the annual audit of the State’s Disproportionate Share Hospital (DSH) payments and will provide an annual calculation of the State’s Certified Public Expenditure (CPE) amount. Additionally, the Contractor will design, implement, and maintain a secure provider portal to facilitate the standardized collection and submission of cost and utilization reports from various provider types, thus supporting data validation, reporting consistency, and timely access to information necessary for oversight.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Nursing Facility Reimbursement Rate Structure associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Pharmacy Actual Acquisition Cost (AAC) Program

Procurement Number: RFQ 31865-00671
Projected Release Date: 1^st Quarter 2027
Summary:

This competitive RFQ seeks to support TennCare’s pharmacy reimbursement methodology in compliance with CMS requirements, including maintaining the Average Actual Acquisition Cost (AAAC)–based ingredient pricing and Professional Dispensing Fee (PDF) structure across a wide range of drug types and pharmacy products. The contract will require 340B technical and reporting services, such as maintaining the Estimated Ceiling Price File. TennCare’s reimbursement model is built on AAAC, reflecting actual drug acquisition costs, and PDF, which is informed by a Cost of Dispensing survey capturing the full range of pharmacy activities. Together, these components ensure compliance with federal regulations and statutory requirements to promote efficiency, cost-effectiveness, quality of care, and adequate provider participation. TennCare regularly updates this methodology through CMS-approved State Plan Amendments.

TennCare, through this competitive RFQ, seeks a contract that will accurately assess pharmacy dispensing costs, establishing consistent and predictable reimbursement rates (including for 340B claims), and ensure compliance with CMS rules requiring AAAC plus a PDF framework. The contract will also ensure timely and accurate pricing and reimbursement for Medicaid pharmacy services. Beyond pharmacy-related responsibilities, the contract will support TennCare’s diaper program by maintaining pricing methodologies, producing quarterly Maximum Allowable Cost (MAC) files, offering help desk support, and managing reimbursement approaches for both listed and non-listed diaper products.

Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Pharmacy AAC associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Social Service Employment and Income Verification Services

Procurement Number: RFP 31865-00667
Projected Release Date: 4th Quarter 2026
Summary:

The Division of TennCare is required, by federal law, to attempt to electronically verify income information prior to requesting documentation verification from TennCare applicants and members. This must be completed via an integrated application programming interface (API) directly with the Tennessee Eligibility Determination System (TEDS) with a real time query and response system that provides instantaneous responses. This income and employment verification data is used to determine if an individual is eligible for TennCare benefits, or if additional documentation will be required for benefit eligibility.

Member Medical Appeals Call Center

Procurement Number: RFP 31865-00668
Projected Release Date: 4th Quarter 2026
Summary:

The State intends to secure a contract for the TennCare Member Medical Appeals (“MMA”) toll-free call center to provide approximately 1.4 million TennCare members and 40,000 CoverKids members the opportunity to file medical appeals in response to a managed care contractor’s (“MCC”) proposed adverse benefit determinations, to file requests for relief from reimbursement and billing, and to allow members to submit requests to change their assigned managed care organization (“MCO”). The MMA call center is anticipated to receive approximately 1200 calls per week.

Patient Centered Medical Home Recognition Program (PCMH)

Procurement Number: RFP 31865-00665
Projected Release Date: 1^st Quarter 2027
Summary:

The State of Tennessee, Division of TennCare (TennCare), Chief Medical Office is seeking a Contractor to implement a rigorous accreditation process for primary care organizations in the Patient Centered Medical Home (PCMH) Model. The Contractor will be expected to:

Maintain a set of precise standards for defining patient-centered care as it pertains to the PCMH Model and leverage these standards as the guiding framework for all activities related to the accreditation process;
Onboard new TennCare PCMH providers and guide them through obtaining PCMH Recognition through the contractor’s established PCMH Recognition program;
Guide current providers and their 450+ PCMH sites through the annual renewal of their PCMH Recognition;
Provide TennCare with detailed monthly project reports outlining assistance given to PCMH providers’ and their sites and updating TennCare with the status of ongoing PCMH Recognition efforts;
Develop, operationalize and provide access to a dashboard for TennCare to track providers’ sites in their progress of initially obtaining and then annually renewing PCMH Recognition; and
- Designate key personnel to deliver the above services, such as a project manager to regularly report on progress to TennCare, a representative to answer provider questions about application processing, and a qualified team of evaluators for the PCMH Model.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation PCMH. You may request this form from the Solicitation Coordinator at Sharon.D.Way@tn.gov

MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS)

Procurement Number: 31865-00662
Projected Release Date: 1st Quarter 2027
Summary:
TennCare seeks a Contractor with the qualifications and experience necessary to assume, operate, migrate to the cloud, and enhance TennCare’s Medicaid Management Information System (MMIS).
TennCare's MMIS solution is used to administer and manage Enrollment in Medicaid Managed Care Organizations (MCOs), as well as capture claims and encounter data from the MCOs. TennCare seeks enhancements to existing capabilities, including but not limited to:
Member Enrollment: Automate the assignment and enrollment of Members to Managed Care Contractors (MCCs) based on the application of eligibility data to TennCare business rules and policies.
Financial Management: Support the centralized management and oversight of TennCare’s financial accounting, payments, receivables/recoveries, reconciliation, budget management, and financial reporting activities across the enterprise.
Encounter Processing: Support the centralized management of Encounter data received from MCCs or a third-party adjudicator, including receipt and processing of encounter data, and applying edits and audits based on TennCare’s business rules.

Medical Appeals

Procurement Number: 31865-00659
Procurement Release Date: 3rd Quarter 2026
Summary:

The Division of TennCare requires the services of a URAC-accredited Independent Review Organization for the provision of independent medical necessity reviews, and expert medical opinion testimony related to (1) TennCare and CoverKids member benefit appeals, (2) TennCare and CoverKids member requests to change their managed care organization (“MCO”) assignment outside of the annual change period, and (3) MCO provider appeals involving claims disputes.

Every TennCare member has the right to appeal an adverse determination (where a medical, dental, or pharmaceutical benefit was denied, reduced, or terminated.) When the denial is due to the MCC determining the service requested is not medically necessary, the Contractor provides an unbiased, third-party review and expert opinion. The right to an appeal is required by CMS and there are associated timelines which the Medicaid agency must abide by. Without the contract, TennCare could not proceed with medical member appeal process.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Medical Appeals associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Workforce Registry

Procurement Number: 31865-00658
Release Date: June 26, 2026
Summary:

The State of Tennessee, Division of TennCare Long Term Services and Supports (LTSS) is seeking competitive bids to join and establish a Contract with an existing web-based direct care/support employer registry system (“Workforce Registry”). The Workforce Registry would serve multiple purposes, including but not limited to: a direct care/support employer registry, reporting capabilities, and a learning management and resource library. It will also provide a job matching portal specific to direct care/support positions for Home and Community Based Services.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Workforce Registry associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Enterprise Testing Services

Procurement Number: 31865-00651
Release Date: July 15, 2026
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 overalhor.tn.gov/sites.html/contl 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.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Enterprise Testing Services associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

TENNESSEE ELIGIBILITY PLATFORM (TEP)

Procurement Number: 31865-00648

Projected Release Date: 3rd Quarter 2026

Summary:

TennCare seeks a Contractor with the qualifications and experience necessary to assume, operate, and enhance TennCare’s Tennessee Eligibility Platform (TEP). TEP 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

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation TEP associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Analytic Support

Procurement Number: 31865-00664
Release Date: 4^th Quarter 2026
Summary:

TennCare is seeking analytics consulting services to contribute 1) support for building general agency capacity in data analytics to make higher value use of our data, and 2) expertise to support state staff in the completion of specific high priority, high complexity analytic projects.