Centralized Credentialing

The State of Nevada, through the Department of Health and Human Services Division of Health Care Financing and Policy (DHCFP), is procuring a Centralized Credentialing solution to manage the credentialing and re-credentialing processes for approximately 42,000 Medicaid enrolled providers across the jurisdictions of Carson City. The selected Credentials Verification Organization (CVO) vendor will be responsible for implementing a robust screening and validation process to ensure only qualified and high-quality providers are enrolled, aligning enrollment processing times and outcomes, and reducing provider administrative burden. The CVO must be NCQA certified at the contract start date and maintain certification throughout the contract term, which is proposed to be from March 1, 2024, through February 28, 2028, with an implementation deadline of December 31, 2024. The CVO will be required to interface with Nevada's existing Fiscal Agent vendor, adhere to rigorous service level agreements, and comply with liquidated damages provisions for failure to meet performance requirements. Vendors must submit proposals through the NevadaEPro system by the July 31, 2023 deadline and will be evaluated on criteria such as demonstrated competence, experience, solution quality, stakeholder engagement, personnel expertise, and cost.

The RFP allows for various pricing models, including fixed monthly fees, per provider fees, or per credentialed file fees, and the state is open to considering the proposed cost method that is in the best interest of Nevada. The RFP does not specify any set-aside designations or restrictions on the types of organizations that can respond. The incumbent vendor and details on any existing credentialing infrastructure are not provided in the materials. The total award value or budget range for this contract opportunity is also not disclosed.