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Opportunity to Comment on Proposed Changes to the TennCare Program

Upcoming Procurements

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


  • RFP # 31865-00603
  • Release Date: June 11, 2021
    • * Posted (see link below)
  • Summary: 
    • The Division of TennCare seeks to secure contracts with three successful Respondents for the provision of statewide Medicaid managed care services for TennCare and CoverKids members and Medicare services for full benefit dual eligible beneficiaries who elect to enroll in the MCO’s aligned Dual Eligible Special Needs Plan (D-SNP). Tennessee's integrated, full-risk, Medicaid managed care program provides covered services to approximately 1.4 million Tennesseans and operates with an annual budget of approximately $12 billion. TennCare covers approximately 20 percent of the state’s population, 50 percent of the state’s births, and 50 percent of the state’s children.

Data Ecosystem

  • Procurement Number: 31865-00619
  • Release Date: May 13, 2021

* Posted (see link below)

  • Summary:
    • TennCare will seek qualified respondents to support the design, development, implementation, operation, and maintenance of comprehensive Data Ecosystem consisting of data cleansing and loading, storage, analytics and data management functionality.
    • The State seeks a cloud-based Data Ecosystem Solution (DE Solution) for the following four (4) Data Ecosystem Components (DE Components):
      • Enterprise Data Warehouse (EDW)
      • Data Quality (DQ)/Extract-Transform-Load (ETL) Pipeline
      • Master Data Management (MDM)
      • Decision Support System (DSS)

Third Party Liability (TPL) Services

  • Procurement Number: RFP #31865-00624
  • Release Date: August 2, 2021
  • Summary:
    • Third Party Liability (“TPL”) refers to the legal obligation of third parties (for example, certain individuals, entities, insurers, or programs) to pay part or all the expenditures for assistance furnished under a State Medicaid program (TennCare is the State’s single state agency Title XIX Medicaid program.)
    • The purpose of this RFP is to identify a supplier to (1) Identify TPRs and assist TennCare with maintenance of TennCare’s Resource File, (2) Identify and recover casualty subrogation related to Pharmacy Claims, Dental Claim and Mass Torts, (3) Provide Medicare Outreach to encourage TennCare Members who are eligible for Medicare to apply for Medicare, (4) Perform an annual review of the payment of Medicare crossover claims by TennCare and its Partners, (5) Provide Credit Balance Audits and recover recoupments, (6) Perform go-behind billing, and (7) Perform additional recovery projects as authorized by TennCare and agreed to by the parties.

Fraud, Waste, and Abuse

  • Procurement Number: 31865-00620
  • Release Date: August 13, 2021
  • Summary:
    • TennCare Seeks a Program integrity (PI) solution that meets the following identified needs:
      • A case management (CM) solution to manage the process, communications, assignments, documentation, status, and results throughout the life cycle of a referral/lead being escalated, investigated, and settled/prosecuted
      • A data analytics component to improve TennCare’s ability to triage, validate, and escalate both self-generated and third-party-referred leads related to Fraud, Waste, and Abuse (FWA), and to help prevent improper payments related to FWA before payments are made. This includes components that include controls to minimize the risk of increasing volume due to false positives.

Closed Loop Referral System (CLRS)

  • Procurement Number: 31865-00626
  • Release Date: 1st Quarter 2022
  • Summary:
    • Non-Medical Risk Factors are adverse conditions in a person’s environment that may negatively impact their health and quality of life. Non-Medical Risk Factors can include economic instability, lack of quality education, food insecurity, housing insecurity, inaccessible healthcare, lack of transportation, and violence in the home or neighborhood.
    • TennCare seeks a Contractor for the design, development, implementation, and operation of a public, cloud-based Closed-Loop Referral System (CLRS or Solution) that meets the following requirements:
  • A standardized non-medical needs assessment embedded within the system
  • Comprehensive, interactive, and up-to-date Community Resource Directory available via a public domain
  • Non-medical risk factors referral system capable of sending electronic referrals to community-based organizations and tracking referral outcomes
  • Capability to associate referrals to a TennCare member and maintain, monitor, and track those referrals over time


  • Procurement Number: 31865-00627
  • Projected Release Date: 2nd Quarter 2022
  • Summary:

TennCare seeks to replace the legacy Medicaid Management Information System (MMIS) through a set of modular solutions centered on Service Oriented Architecture (SOA), delivered as Software as a Service (SaaS), which will include the design, development, implementation, operation, and maintenance of the following three modules:

 Member Enrollment (ME) Module: The ME Module shall 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. The ME Module shall also house the information for existing and newly added Health Plans and Health Benefits.

Financial Management (FM) Module: The FM Module shall support the centralized management and oversight of TennCare’s financial accounting, accounts payable, receivables/recoveries, reconciliation, budget management, and financial reporting activities across the enterprise. The FM Module shall integrate with the State Accounting System to ensure proper accounting and management of funds in alignment with Comptroller of the Treasury (COT) requirements.

Encounter Processing (EP) Module: The EP Module shall support the centralized management of Encounter data received from Managed Care Contractors or a Third-Party Adjudicator. The EP Module shall receive and process Encounter data, and apply edits and audits based on TennCare Business Rules.

If you are interested in any of the above procurements and would like further information, please email with a cc to

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