26EHSPMMHPROBSS MassHealth Provider Operations Business Support Services RFR

Background
The Executive Office of Health and Human Services (EOHHS) is issuing this Request for Responses (RFR) to procure a contractor for business support services for MassHealth, which includes the Medicaid program and the Children's Health Insurance Program in Massachusetts.

The mission of MassHealth is to improve health outcomes for over two million low-income residents by providing access to integrated healthcare services. The goal of this contract is to enhance provider enrollment, communication, and operational efficiency within MassHealth.

Work Details
The contractor will provide a range of business support services including:
- Managing provider enrollment, credentialing, revalidation, onboarding, and data management;
- Delivering provider outreach, education, communication, and relationship management;
- Conducting provider trainings;
- Supporting Electronic Data Interchange (EDI) testing and compliance;
- Assisting with claims processing;
- Providing document management services including imaging and fulfillment;
- Maintaining a Knowledge Center;
- Ensuring quality improvement practices;
- Facilitating Provider Contact Center support;
- Managing technology design and implementation activities;
- Overseeing Non-Emergency Transportation Authorization requests;
- Potentially providing a Health Plan Comparison Tool as directed by EOHHS.

Period of Performance
The contract will commence on October 1, 2026, with an operational start date of July 1, 2027.

The initial term for operational services is five years, ending on June 30, 2032. EOHHS may extend the contract for up to two additional years based on performance and funding availability.

Place of Performance
The services will be performed in Massachusetts as required by the contract specifications.

Bidder Requirements
Bidders must have been in business for at least five years with three years in similar service provision. They must certify that they can perform all required services without any conflicting interests with EOHHS or its subcontractors. Additionally, bidders are required to submit a Supplier Diversity Plan committing at least 1% of contract sales to SDO-certified diverse businesses.