ProviderSvc_Ntwrk_Adequacy_Software_RFI_31865-00733.docx

STATE OF TENNESSEE

DIVISION OF TENNCARE

REQUEST FOR INFORMATION

FOR

GEOGRAPHIC ANALYTIC SOFTWARE FOR TENNCARE NETWORK ADEQUACY

RFI # 31865-00733

August 3, 2026

STATEMENT OF PURPOSE:

The State of Tennessee, Division of TennCare, issues this Request for Information ("RFI") for the purpose of gathering information from qualified vendors regarding commercially available geographic network analysis software, related data services, implementation services, and support services. The State currently uses geographic network analysis software to monitor time and distance standards for provider specialties and to evaluate member access to services in accordance with federal Medicaid managed care network adequacy requirements and State program standards. The State is seeking information to help assess market capabilities, solution approaches, implementation considerations, pricing models, and potential procurement strategies. We appreciate your input and participation in this process.

BACKGROUND:

TennCare administers Tennessee's Medicaid program and oversees managed care contractors and provider networks serving Medicaid members. Network adequacy monitoring supports the State's ability to evaluate whether members have reasonable access to covered services across geographic areas, provider specialties, populations, and service delivery arrangements.

Federal Medicaid managed care rules require states that contract with managed care organizations, prepaid inpatient health plans, or prepaid ambulatory health plans to develop and enforce network adequacy standards. At a minimum, states must develop quantitative network adequacy standards for covered provider types including adult and pediatric primary care, OB/GYN, adult and pediatric mental health and substance use disorder providers, specialists designated by the State, hospitals, pharmacies, pediatric dental providers, and applicable long-term services and supports provider types. States may vary standards by geographic area and must consider factors such as anticipated Medicaid enrollment, expected utilization, population characteristics and health needs, provider supply, and geographic access.

The State is interested in details and information regarding available solutions currently in the market that can support ongoing monitoring, ad hoc analysis, repeatable reporting, and scenario modeling for Medicaid network adequacy.

COMMUNICATIONS:

1.1 Please submit your response to this RFI to:

Johnathon Brock Division of TennCare 310 Great Circle Road, Nashville, TN 37228

(615) 507-6928 Johnathon.S.Brock@tn.gov

1.2 Please feel free to contact the Division of TennCare with any questions regarding this RFI. The main point of contact will be:

Johnathon Brock Division of TennCare 310 Great Circle Rd, Nashville, TN 37228

(615) 507-6928 Johnathon.S.Brock @tn.gov

1.3 Please reference RFI # 31865-00733 with all communications to this RFI.

RFI SCHEDULE OF EVENTS:

EVENT

TIME

(Central Time Zone)

DATE

(all dates are State business days)

August 3, 2026

August 14, 2026

GENERAL INFORMATION:

1.4 Please note that responding to this RFI is not a prerequisite for responding to any future solicitations related to this project and a response to this RFI will not create any contract rights. Responses to this RFI will become property of the State.

1.5 The information gathered during this RFI is part of an ongoing procurement. In order to prevent an unfair advantage among potential respondents, the RFI responses will not be available until after the completion of evaluation of any responses, proposals, or bids resulting from a Request for Qualifications, Request for Proposals, Invitation to Bid or other procurement method. In the event that the state chooses not to go further in the procurement process and responses are never evaluated, the responses to the procurement, including the responses to the RFI, will be considered confidential by the State.

1.6 The State will not pay for any costs associated with responding to this RFI.

INFORMATIONAL FORMS:

The State is requesting the following information from all interested parties. Please fill out the following forms:

RFI # 31865-00733

TECHNICAL INFORMATIONAL FORM

1. Respondent Legal Entity Name:

2. Respondent Contact Person:

Name, Title:

Address:

Phone Number:

Email:

3. Brief description of experience providing similar scope of services/products:

4. Does your organization’s solution offer all of the following?

5. Describe your organization’s ability to measure member access to provider networks by time, distance, provider type, specialty, age group, plan, region, county, zip code, compound analysis and other State-defined query criteria.

6. Describe your organization’s experience supporting CMS and State network adequacy monitoring, reporting, and oversight activities, including routine production runs and ad hoc reports

7. Describe your organization’s ability to evaluate provider network changes, provider terminations, new provider additions, service area changes, managed care contractor submissions, and potential network exceptions.

8. Describe your organization’s ability to integrate with provider directory, enrollment, claims/encounter, eligibility, managed care plan, geographic boundary, and reference datasets.

9. Describe your organization’s ability to improve transparency of reporting algorithms, geocoding quality, provider/member matching, and network adequacy results.

10. Describe your organization’s ability to provide secure, auditable, accessible, and user-friendly reporting for program, compliance, actuarial, analytics, and procurement stakeholders.

COST INFORMATIONAL FORM

1. Describe what pricing units you typically utilize for similar services or goods (e.g., per hour, each, etc.:

2. Describe the typical price range for similar services or goods:

ADDITIONAL CONSIDERATIONS

1. Please provide input on alternative approaches or additional things to consider that might benefit the State:

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