North Carolina Replacement Medicaid Management
This document is the State of North Carolina's Request for Proposal (RFP) for the
development and implementation of a Replacement Medicaid Management Information
System (MMIS) by a Vendor, who shall also operate the system and perform other
Medicaid-related functions as the State's Fiscal Agent. The Replacement MMIS will
replace the State's federally certified Legacy MMIS+.
The Division of Medical Assistance (DMA) within the North Carolina Department of
Health and Human Services (NC DHHS) uses the Legacy MMIS+ to process Medicaid
claims. Because the existing MMIS interacts with the State's Integrated Payment and
Reporting System (IPRS) to process the non-Medicaid claims of NC DHHS' Division of
Mental Health, Developmental Disabilities, and Substance Abuse Services (DMH), the
State refers to the MMIS and its IPRS-specific business areas collectively as the
multi-payer Legacy MMIS+.
The NCMMIS+ Program was initiated to manage the activities related to the
procurement and implementation of systems and services for the Replacement MMIS
as well as systems and services for Reporting and Analytics (R&A) and an information
technology (IT) system for the Division of Health Service Regulation (DHSR), formerly
the Division of Facility Services (DFS). This RFP contains information on the
Replacement MMIS business areas. Subsequent RFPs will address the requirement for
the other business areas in the NCMMIS+ Program.
The Replacement MMIS will expand claims payment functionality to include the Division
of Public Health (DPH), the Migrant Health Program in the Office of Rural Health and
Community Care (ORHCC), DMA, and DMH. For additional information about all
affected NC DHHS divisions, refer to the Procurement Library.
This RFP contains a high-level Statement of Objectives (SOO) section as well as
detailed requirements in Section 40. The State encourages Offerors to propose
solutions and innovative approaches to achieve those solutions that are consistent with
the objectives set forth in this RFP.
