26EHSPMMHPROBSS MassHealth Provider Operations Business Support Services RFR

The Massachusetts Executive Office of Health and Human Services is requesting proposals for comprehensive business support services for MassHealth, with responses due June 22, 2026 at 5:00 p.m. Eastern Time. This is a single-award RFR for a five-year operational contract (July 1, 2027 through June 30, 2032) with two optional extension years available through June 30, 2034, preceded by a nine- to twelve-month implementation period beginning October 1, 2026.

The scope encompasses provider enrollment and credentialing, provider revalidation, contact center operations, claims processing, document management and fulfillment, non-emergency transportation authorization, provider education and training, Electronic Data Interchange testing, and provider portal and digital services supporting a network of approximately 120,000 unduplicated providers and 2 million low-income residents. The contractor must process monthly volumes including 751 enrollment applications, 3,024 provider file update requests, 2,500 suspended waiver claims, and 50,000 non-emergency transportation requests. All services require HIPAA Business Associate compliance, participation in Electronic Funds Transfer programs, and prompt payment discounts.

Bidder qualifications include minimum five years in business with at least three years performing similar Medicaid services, no financial or legal conflicts with EOHHS' External Quality Review Organization, and demonstrated experience with large-scale healthcare operations. Bidders must submit audited financial statements for the prior two years and certify sound financial condition. All bidders must commit a minimum 1% of contract sales to certified diverse businesses (MBE, WBE, SDVOBE, VBE, disability-owned, LGBTBE, or nonprofit organizations), with higher commitments earning additional evaluation points.

The administrative costs plus earnings factor are capped at 12.5% of total annual contract costs. Evaluation criteria include business response (organizational overview, financial condition, security policies), programmatic response (Medicaid experience, implementation plan, staffing strategy, responses to 23 programmatic scope questions), and cost response. A bidders' conference was held May 7, 2026; written inquiries were due May 14, 2026, with responses posted by May 28, 2026. Oral presentations and product demonstrations are anticipated for July 23, 2026, with best and final offers due August 20, 2026 if requested. Award notification is anticipated September 15, 2026, with contract effective date October 1, 2026. All responses must be submitted electronically through COMMBUYS.