BSS RFR - Bidders Conference Presentation.pdf

MassHealth Claims and Provider Operations

Business Support Services RFR

Bidders’ Conference: 05/07/2026

Procurement Name: 26EHSPMMHPROBSS MassHealth Provider Operations Business

Support Services RFR

BID Number : BD-26-1039-EHS01-ASHWA-128591

Agency: Executive Office of Health and Human Services

RFR Issued : 04/24/2026

Bidder’s Response Due : 06/18/2026

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official procurement documents.

Agenda

➢ Welcome and Introductions

➢ Opening Remarks

➢ Programmatic Updates

➢ Overview

➢ Timeline

➢ Bidder Qualification

➢ Business Response

➢ Programmatic Response

➢ Programmatic Scope

➢ Cost Response Overview

➢ RFR Structure and Attachments

➢ Submission Requirements and

➢ Written Questions

Provider and Claims Operations5/7/2026 2

➢ Provider Operations

✓ Janice Wadsworth

➢ Claims Operations

✓ Lorraine Ladderbush

➢ Project Manager

✓ Rosina Valiyamannathal

➢ Legal

✓ Tim Hoitink

➢ Procurement Team

✓ Kalinda Collins

✓ Shukri Osman

➢ Leadership Sponsors

✓ Monica Sawhney

✓ Kartikey Trivedi

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Welcome and Introductions

Kalinda Collins, Procurement Coordinator

➢ Verbal responses are not binding.

➢ Submit all questions in writing by May 14, 2026, at 5:00 p.m.

➢ EOHHS may prepare written responses to questions it determines are of general interest.

➢ Only written responses posted on COMMBUYS will be binding on EOHHS.

➢ Updates, amendments, clarifications, and written Q&A will be posted on COMMBUYS. Check the site regularly.

➢ Bidders must register as COMMBUYS sellers, submit electronic quotes through COMMBUYS, and comply with COMMBUYS submission requirements and file limits. See RFR Sections 7.4-

7.8.

➢ Other than today’s Bidders’ Conference, bidders may communicate with EOHHS only as specified in the RFR. See RFR Section 7.9

➢ Recordings and AI transcription are not permitted.

➢ RFR Contact: Kalinda Collins, Procurement Coordinator, kalinda.collins@mass.gov

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official procurement documents.

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Opening Remarks mailto:kalinda.collins@mass.gov

MassHealth Claims and Provider Operations Business Support Services RFR

Program Team Updates

➢ EOHHS is issuing this RFR in accordance with state procurement regulations (801 CMR 21.00), requiring a competitive bidding process.

➢ MassHealth provides comprehensive, affordable healthcare coverage to over 2 million low-income residents, including a significant portion of children and individuals with disabilities.

➢ MassHealth collaborates with a large network of providers (~120,000) and numerous state, federal, and private partners to deliver services and support program operations.

➢ Operational Metrics and Information are available in “Attachment C – Reference Material” to assist potential Bidders in preparing response submissions.

➢ Solicit qualified vendors to provide comprehensive Business Support Services (BSS) for

MassHealth.

➢ Key Dates: Contract Effective Date : Oct 1, 2026; Implementation period through June 30, 2027;

Operational Start Date: July 1, 2027

➢ Contract Term: Implementation period plus five (5) years (July 1, 2027 – June 30, 2032), with up to two (2) optional extension years

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Overview

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to

COMMBUYS for the official procurement documents.

➢ RFR issued: April 24, 2026

➢ Bidders’ conference: May 7, 2026

➢ Bidders’ Written Inquiries Due : May 14, 2026, by 5:00 p.m. ET

➢ EOHHS written responses to Inquiries (anticipated): May 28, 2026

➢ BIDDERS’ RESPONSES DUE: June 18, 2026, by 5:00 p.m. ET

➢ Oral Presentation/Product Demonstration/Staff Interview (anticipated): July 23, 2026

➢ Best and Final Offer Due, if requested by EOHHS: August 20, 2026

➢ Date for Notifying Bidders of Selection (anticipated): September 15, 2026

➢ Contract effective (anticipated): October 1, 2026

➢ Implementation & go-live (anticipated): by June 30, 2027

➢ Anticipated Contract Operational Start: July 1, 2027

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Timeline

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

Bidders must:

➢ Certify ability to perform all required services and obligations as detailed in Attachment A

➢ Have been in business for a minimum of 5 years, at least three of which must have been in a business performing some similar services or related activities

➢ No financial, legal, or business conflicts with EOHHS’ External Quality Review Organization

(EQRO) or its subcontractors.

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Bidder Qualification (Section 2.2)

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

A. Organization overview

➢ Include Legal name, ownership structure, and entity type.

➢ Key leadership, Board of Directors, and organizational chart

➢ Parent, subsidiaries, and affiliated entities

B. Requirements regarding subcontractors

➢ Identify all subcontractors (name, contact, SDO status)

➢ Define roles, responsibilities, and management approach

➢ Confirm all subcontract agreements comply with contract terms

C. Interests

➢ Disclose all financial, legal, and business relationships

➢ Identify potential conflicts and mitigation strategies

➢ List related entities and Commonwealth contracts

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Business Response (Section 5.2)

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

D. Bidder’s Financial Condition

➢ Audited financial statements (last 2 years)

➢ Certification of financial stability and tax compliance

➢ Disclosure of audits, bankruptcy, or financial risks

➢ Certificate from taxing authority / Certificate of Good Standing, as applicable.

E. Security Polices and Procedure/ F. Disclosure of litigation

➢ Security policies and data breach history (last 5 years)

➢ Disclosure of material litigation

G. Cover Letter

➢ Cover letter confirming acceptance of RFR terms, consistent with RFR requirements

H. Required Forms and Certifications

➢ Submit all required forms and certifications per RFR requirements

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Business Response (Section 5.2)

Continued..

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

A. Bidder experience with Medicaid and similar organizations

➢ Demonstrated experience with Medicaid, Medicare, and large-scale healthcare operations

➢ Relevant past performance with state agencies (including Massachusetts) and client references

B. References

➢ Complete and submit Business Reference Forms for three references

➢ References must reflect similar services as outlined in Attachment A

C. Approach Narrative

➢ Understanding of requirements, risks, and constraints

➢ Staffing and resource allocation approach

➢ Systems development, integration, and testing strategy

➢ Performance monitoring and subcontractor oversight

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Programmatic Response (Section 5.3)

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

D. Project Plan

➢End-to-end implementation plan with key milestones (transition to go-live)

➢Task timelines, dependencies, and deliverables

➢Defined roles, responsibilities, and ownership

➢Clear path to operational readiness

E. Bidder’s Organization

➢Organizational structure with key roles and responsibilities

➢Org charts for transition and operational phases

➢Subcontractor roles and integration

➢Staff loading and ramp-up plan

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Programmatic Response (Section 5.3)

Continued..

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

F. Subcontracting

➢ Identify subcontractors and key details

➢Summarize experience and capabilities

➢Define roles and scope of work

➢Outline coordination and management approach

G. Detailed Response Questions

➢Demonstrate experience, approach, risks, and success measures

➢ Include supporting samples (if available)

➢Optional components may be addressed (Health Plan Comparison Tool)

➢Scope detailed in next slide

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Programmatic Response (Section 5.3)

Continued..

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

1. Relevant Business Support Services Experience

2. Provider Portal and Digital Services

3. Non-Emergency Transport Authorization

4. Provider Enrollment, Credentialing, Re-Enrollment, and Revalidation

5. Provider Review Committee

6. Provider Data Management and Maintenance

7. Provider Materials

8. Provider Contact Center

9. Provider-Related Audit Support

10.Provider Claims

11.Electronic Data Interchange (EDI) Trading Partner

Testing

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Programmatic Scope

12. Provider Education, Outreach, and

Communications and Onboarding

13. Document Management

14. Fulfillment and Mailing

15. Marketing

16. Health Plan Comparison Tool (optional)

17. Provider Directory

18. Customer Surveys

19. Reporting

20. System Integration and Interfaces

21. Performance & Service Level Agreements (SLA)

22. Transition Approach

23. Other

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

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Cost Response Overview

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official procurement documents.

Total Cost Includes: Implementation costs, Contract costs for Years 1 through 5, and optional extension

Years 1 and 2.

1. Contract Costs (Years 1 through 5 + Extensions) : Include all direct, indirect, and administrative costs across the full contract term (5 + 2 years)

2. Implementation Costs Include: All costs associated with start-up and implementation activities, including:

➢ Provider Enrollment and Revalidation

➢ Provider Data Management

➢ Provider Training and Onboarding

➢ Provider Contact Center (chat, email, outreach)

➢ Claims processing (paper claims and 90-day waiver)

➢ Document Management, Fulfillment, and Mailing

➢ NETA

➢ Provider Directory

➢ Provider Misc / Business Operations (EDI, audit, provider materials, PRC)

➢ Software / Portal

➢ MassHealth Choices (optional)

COMMBUYS Submission

➢ Submit electronic Quote via COMMBUYS by the specified deadline

➢ Active COMMBUYS Seller account required

➢ Late or alternate submissions (email/fax) will not be accepted

Response Structure

Bidders must submit three components:

➢ Business Response, Programmatic Response and Cost Response

Each document must be clearly labeled with:

➢ RFR title, Bidder legal name and Document type

Response Format

➢ Follow RFR structure with matching headings and numbering

➢ Include a table of contents

➢ Respond to all required sections

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Submission Requirements

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

➢ Business Support Services RFR

➢ Attachment A : Model Contract

➢ Appendix A : Service Level Agreements

➢ Appendix B : Payment Schedule

➢ Appendix C : Data Management and Confidentiality Agreement (DMCA)

➢ Appendix D : Secretariat Application Reference Manual

➢ Appendix E : MES Outcome – CMS-Required Provider Management

➢ Appendix F : Regulatory References

➢ Appendix G : Medicaid Enterprise Technical Requirements for the MassHealth Provider Services Module Replacement

➢ Appendix H : Business Support Services – Concept of Operations Diagram

➢ Attachment B : Cost Response Instructions and Workbook

➢ Attachment C : Reference Materials

➢ 1. Provider Types

➢ 2. Provider Application Cover Letter and Check List – Independent Clinic/Center

➢ 3. Provider Application - Independent Clinic/Center

➢ 4. Provider Application Cover Letter and Check List - Medical Practitioner

➢ 5. Provider Application – Medical Practitioner

➢ 6. Provider Application and Contract – Ordering, Referring and Prescribing (ORP)

➢ 7. BSS Average Monthly Volume

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RFR Structure and Key Attachments

➢ Submission Method:

➢ All Questions must be submitted in writing via email to the RFR Contact

➢ COMMBUYS Q&A functionality may also be used (email preferred)

➢ Requirements:

➢ Submit in Word document or plain text email

➢ Questions must be numbered (not in table format)

➢ Deadline:

➢ Questions must be submitted by the Bidder’s Written Inquiries Due date (per

Procurement Timetable - May 14, 2026 by 5:00 p.m. ET)

➢ Questions received after the deadline may be disregarded.

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Written Questions

*This presentation is for informational purposes only and does not supersede the RFR or its attachments. Please refer to COMMBUYS for the official

THANK YOU!

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