RFP Sourcing Event - Provider Data Management_Credentialing Verification Office RFP

The North Carolina Department of Health and Human Services (NCDHHS) is seeking a Provider Data Management Credentialing Verification Organization (PDM/CVO) solution. The solution 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. Key features of the solution include: • Consolidating all provider data to reduce administrative redundancy for providers • Simplifying enrollment, data maintenance, and revalidation processes • Facilitating centralized credentialing on behalf of NCDHHS payers and health plans • Potentially mitigating reimbursement errors caused by outdated provider data • Allowing for delegated enrollment and credentialing • Aligning North Carolina’s credentialing process with NCQA standards • Establishing a representative centralized Credentialing Committee with representatives from NCDHHS payers and health plans The solution will be implemented through a multi-phase initiative, the MMIS Replacement Project, which 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 PDM/CVO solution will consist of high-level items, including data management, enrollment, credentialing, and data sharing • The solution will meet NCQA standards and enhance provider credentialing through centralized CVO features • The solution will be implemented through a multi-phase initiative, the MMIS Replacement Project • The solution 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