We are excited to announce a New England-focused Medicaid Enterprise Systems Community event next Spring (April 7-9, 2025) in Providence, RI. The event will bring together the Medicaid Enterprise Systems Community for the Northeast Regional Demonstrations meeting, aka the “NERDS”, and will be similar in form to one held in 2019. Our goal is to connect you, the leading private sector organizations, with State Medicaid Agency (SMA) staff from throughout the region to highlight the innovative solutions that your organization provides.

 At the event you will be able to provide in-depth insights about your product(s) or service(s) through seventy-five (75) minute demonstrations and exchange meaningful dialogue about how your organization can address the challenges the SMAs face.

 I invite you to read on and hope that you will submit an application (or two) and join us as we bring together our MES Community.

 Regards,

 David

Areas of Focus:

The regional teams have identified the following areas where they want to learn more from you, and your organization, on how to improve services for their states. The primary areas of focus are:

  • Claims and Encounter Processing: Claim and encounter processing including edits, pricing and verification of prior authorizations.
  • Provider Management: Provider processing including enrollment, data maintenance and credentialing processes. Also includes online provider directories and provider portal / mobile applications.
  • Pharmacy: Pharmacy point-of-sale processing including drug utilization review, preferred drug lists, and drug prior authorizations. Also includes drug rebate processing.
  • Advancing Program Integrity: Systems to detect and prevent fraud, waste, and abuse to promote program integrity. Include current or future plans for incorporating artificial intelligence.
  • Financial Management/Fiscal Agent: Systems which produce accurate budgeting, cost control, and interface with claims systems for timely payments to providers and other stakeholders.
  • EDI/API/FHIR Processing: Systems and interfaces which enable seamless data exchange between Medicaid systems, other healthcare systems, and Medicaid clients and authorized third parties. Include how this helps compliance with federal regulations.
  • Integrated Eligibility & Enrollment System (including Medicaid Client Portal & Mobile App): Eligibility and Enrollment processing for Medicaid, CHIP and other benefit programs. Includes Medicaid client portals/mobile applications for member access to and update (where authorized) of their data.
  • LTSS & HCBS: Adjudication of LTSS/HCBS claims to produce payable amounts for claim payment systems. Includes EVV process to match verification of delivered services to claims.
  • Transformed-MSIS Processing: T-MSIS provides critical data to CMS for program management, policy analysis, and reporting. Include information about the level of data quality from any existing clients.
  • Data Analytics/Business Intelligence/Decision Support: Data analytics including artificial intelligence to help identify trends, measure performance, and optimize program operations. Include information about data storage solutions such as commercial / government cloud providers which are off
  • Unified Call Center Systems/Services: Systems and services which provide a single point of contact for members, providers, and other stakeholders, to improve customer service and reduce call handling time.
  • System Integration Platforms/Services: Integration platforms/services that facilitate seamless data exchange between different systems. Include information about the systems and specific services off
  • Organizational Change Management Services: Medicaid organizations are constantly undergoing change to address federal and state legislative requirements as well as implement new technologies. Specify the services offered to help guide state Medicaid programs in making these organizational changes.

 

Application Process:

We have designed a brief application process for you to complete.

For reference a PDF of the application can be accessed at: Click Here to View the Application

The application is straight forward and should only take about fifteen (15) minutes to complete. There is no cost to apply and you may submit an application for as many topics as appropriate.

Responses are due by January 10, 2025, no later than 5:00 PM Eastern.

Selected organizations will be notified via e-mail by early February 2025.

Cost:

To offset the cost of the event each selected application will be assessed a fee of $6,000 which includes the following:

Seventy-five (75) minute product demonstration session with SMA staff (no other vendors will be allowed access to your session)

  • Session room set to accommodate up to 50-60 people, complete audio-visual room set and support, internet (general Wi-Fi and room specific)
  • Overnight accommodations for one night for three (3) of your team members at the host hotel along with networking dinner tickets for three (3) of your team members to the Monday and/or Tuesday evening events based on the day(s) of your session(s).
  • Scheduled meals, breaks and refreshments served throughout the event.

 Submit Your Application Here!

Stay Connected

If you have any questions, please don’t hesitate to reach out and contact me at 508.365.7833.

David Huffman

Executive Director

New England States Consortium Systems Organization

508.365.7833

david.huffman@nescso.org