AI Solutions

The Vendor is required to provide solutions for AI agents, specialized large language model (LLM), robotic process automation (RPA), and artificial intelligence (AI) to transform Medicaid and public health operations.
1. Medicaid eligibility and enrollment agent
•    Description: AI agent automates Medicaid eligibility determination and enrollment, verifying income, household data, and aca criteria.
•    Demo video requirements: show agent processing mock application, verifying data, determining eligibility, and enrolling applicant in health choice MCO.
•    Technical details: on-premises; integrates with MMIS, health connection; HIPAA -compliant.
2. Medicaid ex-parte renewal agent
•    Description: AI agent automates ex-parte renewals by cross-referencing enrollee data with state and federal sources (e.g., snap, tax records) to confirm ongoing eligibility without manual input, per CMS guidelines.
•    Demo video requirements: show agent pulling mock enrollee data, verifying eligibility via external sources, and completing renewal.
•    Technical details: on-premises; integrates with MMIS, federal hubs; act compliant.
3. Medicaid redetermination agent
•    Description: AI agent manages redeterminations for enrollees not eligible for ex-parte, sending notices, collecting responses, and updating eligibility status. 
•    Flags cases for human review if discrepancies arise.
•    Demo video requirements: show agent sending mock notice, processing response, updating eligibility, and flagging discrepancy.
•    Technical details: on-premises; integrates with MMIS, CRM systems; HIPAA -compliant.
4. Medicaid claims processing agent
•    Description: AI agent automates claims validation, adjudication, and payment, replacing Cobol-based MMIS functions. 
•    Detects errors, ensures compliance with CMS rules, and flags fraud.
•    Demo video requirements: show agent validating mock claim, correcting errors, adjudicating, and issuing payment.
•    Technical details: on-premises; replaces MMIS components; HIPAA -compliant.
5. Medicaid appeals and grievances agent
•    Description: AI agent automates processing of enrollee and provider appeals and grievances, analyzing submissions, routing to appropriate staff, and tracking resolutions per CMS timelines.
•    Demo video requirements: show agent receiving mock appeal, analyzing documents, routing to staff, and updating status.
•    Technical details: on-premises; integrates with MMIS, CRM; act-compliant.
6. Medicaid fraud, waste, and abuse detection agent
•    Description: AI agent uses machine learning to detect fraudulent claims, billing anomalies, or abuse patterns, flagging suspicious cases for investigation and integrating with department program integrity unit.
•    Demo video requirements: show agent analyzing mock claims, identifying fraud pattern, and generating alert.
•    Technical details: on-premises; integrates with MMIS, analytics platforms; HIPAA -compliant.
7. Medicaid advance planning document (APD) agent with specialized LLM
•    Description: AI agent with a specialized LLM fine-tuned for CMS APD processes automates drafting, submission, and monitoring of APDs for federal funding. 
•    Uses CMS-specific terminology and guidelines.
•    Demo video requirements: show agent extracting data, LLM drafting APD, submitting to mock CMS portal, and displaying status.
•    Technical details: on-premises LLM; integrates with Medicaid systems; act compliant; fine tuned on CMS rules.
8. Medicaid provider enrollment and credentialing agent
•    Description: AI agent automates provider enrollment, verifying credentials, licenses, and compliance with agency requirements. 
•    Updates provider registries and flags discrepancies.
•    Demo video requirements: show agent verifying mock provider data, enrolling provider, and updating registry.
•    Technical details: on-premises; integrates with MMIS, NPDB; HIPAA -compliant.
9. Medicaid member services chat-bot
•    Description: AI chat-bot handles enrollee inquiries (e.g., benefits, MCO selection, provider directories) in multiple languages, integrating with knowledge bases and escalating complex issues.
•    Demo video requirements: show chat-bot answering mock inquiry, providing benefits info, and escalating query.
•    Technical details: on-premises or secure cloud; integrates with MMIS, CRM; HIPAA compliant.
10. Specialized Medicaid LLM for unified operations
•    Description: specialized LLM fine-tuned on state Medicaid policies, CMS regulations, and department data unifies eligibility, claims, compliance, and member services. 
•    Provides real-time guidance, drafts documents, and supports AI agents, aiming to replace legacy MMIS.
•    Demo video requirements: show LLM drafting eligibility notice, answering compliance query, and supporting claims agent.
•    Technical details: on-premises LLM; integrates with MMIS, health connection; act-compliant; fine-tuned on Medicaid data.
11. AI for procurement and solicitation management
•    Description: AI system drafts solicitations, assists bid evaluations, and manages financials (e.g., budget tracking, invoice reconciliation). 
•    Uses NLP for compliant documents.
•    Demo video requirements: show AI drafting sample RFP, evaluating mock bids, and generating financial report.
•    Technical details: on-premises or secure cloud; integrates with procurement systems; complies with state regulations.
12. Project management AI agent
•    Description: AI agent manages project timelines, budgets, and deliverables for department initiatives. 
•    Integrates with project management tools, predicts risks, and generates reports.
•    Demo video requirements: show agent creating timeline, assigning tasks, flagging delay, and generating report.
•    Technical details: on-premises or cloud; integrates with Microsoft project; ensures data security.
13. RPA for data entry and record reconciliation
•    Description: RPA automates data entry and reconciliation across department systems (e.g., patient records, grants). 
•    Extracts data from unstructured sources (e.g., pdfs) and updates databases.
•    Demo video requirements: show bot extracting data from mock pdf, validating, and updating database.
•    Technical details: on-premises; integrates with EHR and databases; HIPAA -compliant.
14. AI for public health surveillance and analytics
•    Description: AI analyzes public health data to detect trends, predict outbreaks, and support health equity. 
•    Generates insights and visualizations.
•    Demo video requirements: show AI analyzing mock data, identifying outbreak, and presenting dashboard.
•    Technical details: on-premises or secure cloud; integrates with health databases; HIPAA compliant.
15. AI agent for regulatory compliance monitoring
•    Description: AI agent monitors compliance with regulations (e.g., HIPAA, CMS) by auditing processes, flagging issues, and recommending actions. 
•    Provides alerts and reports.
•    Demo video requirements: show agent auditing mock process, identifying violation, and generating report.
•    Technical details: on-premises or cloud; integrates with audit systems; act compliant.
16. AI for grant management
•    Description: AI automates grant applications, tracks funding, and monitors performance. 
•    Generates outcome reports and ensures compliance.
•    Demo video requirements: show AI drafting grant application, tracking expenses, and producing report.
•    Technical details: on-premises or secure cloud; integrates with financial systems; complies with federal and state rules.
17. AI agent for workforce training and knowledge management
•    Description: AI agent supports staff training by recommending learning paths, answering policy questions, and maintaining a knowledge base of department procedures.
•    Demo video requirements: show agent suggesting training module, answering policy question, and retrieving procedure.
•    Technical details: on-premises or cloud; integrates with HR systems; ensures data security.
18. RPA and AI for it testing automation
•    Description: RPA and AI automate software testing for department it systems (e.g., EHRs, portals). 
•    Generates test cases, executes tests, identifies bugs, and produces reports. 
•    Integrates with testing frameworks (e.g., selenium).
•    Demo video requirements: show solution generating test case, executing test, identifying bug, and displaying report.
•    Technical details: on-premises; integrates with testing tools; ensures secure data handling.
19. AI for code development and optimization
•    Description: AI assists developers by generating, reviewing, and optimizing code for custom applications (e.g., health dashboards). 
•    Ensures security standards and supports python, java, SQL.
•    Demo video requirements: show AI generating python script, suggesting optimization, and flagging vulnerability.
•    Technical details: on-premises or secure cloud; integrates with ides; ensures secure code practices.
20. RPA and AI for mainframe interaction and modernization
•    Description: RPA and AI automate interactions with legacy mainframe systems (e.g., Medicaid claims). 
•    Extracts data, performs transactions, and syncs with modern systems (e.g., APIs, databases).
•    Demo video requirements: show solution extracting data from mock mainframe, performing transaction, and syncing to database.
•    Technical details: on-premises; integrates with mainframes, modern systems; HIPAA compliant.
21. Medicaid prior authorization agent
•    Description: AI agent automates prior authorization requests for Medicaid services (e.g., specialty care, medications). 
•    Validates requests against, routes for approval, and notifies providers and enrollees.
•    Demo video requirements: show agent processing mock prior authorization request, validating criteria, routing for approval, and sending notification.
•    Technical details: on-premises; integrates with MMIS, EHRs; HIPAA compliant.
22. Medicaid waiver program agent
•    Description: AI agent manages Medicaid waiver programs (e.g., home and community-based services). 
•    Automates eligibility checks, service plan creation, and compliance with cms waiver requirements.
•    Demo video requirements: show agent verifying mock waiver eligibility, generating service plan, and confirming CMS compliance.
•    Technical details: on-premises; integrates with MMIS, case management systems; act-compliant.
23. Medicaid cost reporting and analytics agent
•    Description: AI agent automates Medicaid cost reporting, analyzing expenditures, FMAP reimbursements, and MCO performance. 
•    Generates dashboards for budget forecasting and CMS reporting.
•    Demo video requirements: show agent analyzing mock expenditure data, calculating FMAP, and presenting dashboard.
•    Technical details: on-premises or secure cloud; integrates with financial systems, MMIS; HIPAA -compliant.
24. Medicaid interoperability agent
•    Description: AI agent enhances Medicaid data interoperability, syncing MMIS with crisp, state health connection, and federal hubs (e.g., t-MSIS). 
•    Ensures seamless data exchange for analytics and reporting.
•    Demo video requirements: show agent syncing mock MMIS data with crisp, formatting for t-MSIS, and confirming exchange.
•    Technical details: on-premises; integrates with MMIS, crisp, APIs; act compliant.
25. IT system migration agent for Medicaid modernization
•    Description: AI agent automates migration of Cobol-based MMIS to modern cloud-native systems. 
•    Maps data, converts code (e.g., COBOL to java), and validates migrated processes.
•    Demo video requirements: show agent mapping mock MMIS data, converting COBOL snippet, and validating migrated claims process.
•    Technical details: on-premises; integrates with MMIS, modern platforms; HIPAA -compliant.
26. IT cybersecurity agent for Medicaid systems
•    Description: AI agent monitors Medicaid it systems (e.g., MMIS, health connection) for cyber threats, detecting anomalies, and automating incident response (e.g., isolating breaches).
•    Demo video requirements: show agent detecting mock intrusion in MMIS, isolating threat, and generating incident report.
•    Technical details: on-premises; integrates with SIEM tools, MMIS; act -compliant.
27. IT performance optimization agent for Medicaid applications
•    Description: AI agent optimizes performance of Medicaid applications (e.g., MMIS, provider portals) by analyzing latency, resource usage, and user feedback, recommending improvements.
•    Demo video requirements: show agent analyzing mock MMIS latency, suggesting optimization, and improving response time.
•    Technical details: on-premises; integrates with monitoring tools, MMIS; HIPAA -compliant.
28. Mainframe data extraction and archiving agent
•    Description: AI agent automates extraction of data from Cobol-based mainframe systems (e.g., Medicaid MMIS) for archiving or migration to modern databases. 
•    Validates data integrity and formats for cloud-native storage.
•    Demo video requirements: show agent extracting mock MMIS data, validating integrity, and archiving to a modern database.
•    Technical details: on-premises; integrates with mainframes, databases; HIPAA compliant.
29. Mainframe transaction automation RPA
•    Description: RPA bot automates repetitive mainframe transactions (e.g., Medicaid claims updates, financial reconciliations) via terminal emulation, reducing manual input on Cobol systems.
•    Demo video requirements: show bot navigating mock mainframe terminal, executing claims update, and logging results.
•    Technical details: on-premises; integrates with tn3270 emulators, MMIS; HIPAA -compliant.
30. Mainframe error detection and resolution agent
•    Description: AI agent monitors Cobol-based mainframe logs for errors (e.g., batch job failures in MMIS), diagnoses issues, and automates resolutions or escalates to it staff.
•    Demo video requirements: show agent detecting mock batch job error, diagnosing cause, and applying fix or escalating.
•    Technical details: on-premises; integrates with mainframe logs, itsm tools; act compliant.
31. Mainframe-to-API integration agent
•    Description: AI agent creates and manages APIs to connect Cobol-based mainframe data (e.g., Medicaid records) to modern applications, enabling real-time access without manual data transfers.
•    Demo video requirements: show agent generating API for mock MMIS data, enabling access via a modern app.
•    Technical details: on-premises; integrates with mainframes, API gateways; HIPAA -compliant.
32. Mainframe workload optimization RPA
•    Description: RPA bot optimizes mainframe workload scheduling (e.g., Medicaid batch jobs) by prioritizing tasks, reducing resource bottlenecks, and minimizing processing time.
•    Demo video requirements: show bot analyzing mock MMIS job queue, rescheduling tasks, and improving throughput.
•    Technical details: on-premises; integrates with mainframe schedulers, monitoring tools; HIPAA -compliant.
33. Mainframe security compliance agent
•    Description: AI agent audits Cobol-based mainframe access logs and configurations for compliance with act and state cybersecurity policies, flagging unauthorized access or vulnerabilities.
•    Demo video requirements: show agent auditing mock MMIS access logs, identifying unauthorized access, and generating compliance report.
•    Technical details: on-premises; integrates with mainframe security tools; act compliant.
34. AI communications mining for reportable events and incidents in mental health facilities
•    Description: AI system uses NLP and communications mining to analyze unstructured data (e.g., patient notes, staff emails, incident reports) in mental health hospitals to detect reportable events (e.g., patient safety incidents, abuse allegations) and flag for regulatory reporting 
•    Prioritizes urgent cases for immediate action.
•    Demo video requirements: show AI scanning mock patient notes and staff emails, identifying a reportable incident (e.g., restraint misuse), and flagging for proper reporting with priority alert.
•    Technical details: on-premises; integrates with EHRs, email systems; act compliant; uses fine-tuned NLP models.
35. RPA for mental health patient record reconciliation
•    Description: RPA bot automates reconciliation of patient records across mental health hospital systems (e.g., EHRs, billing, Medicaid MMIS), extracting data from unstructured sources (e.g., scanned forms) and updating databases to ensure accuracy for treatment and billing.
•    Demo video requirements: show bot extracting data from mock scanned intake form, validating against EHR, and updating MMIS.
•    Technical details: on-premises; integrates with EHRs (e.g., epic, nets mart), MMIS; HIPAA compliant.
36. AI mental health treatment plan agent
•    Description: AI agent generates and monitors individualized treatment plans for mental health patients, using patient history, diagnoses, and evidence-based guidelines. 
•    Adjusts plans based on progress and alerts clinicians to deviations.
•    Demo video requirements: show agent creating mock treatment plan for a patient with bipolar disorder, adjusting based on progress notes, and alerting clinician.
•    Technical details: on-premises; integrates with EHRs, clinical decision support systems; HIPAA -compliant.
37. Mainframe bed registry agent for mental health facilities
•    Description: AI agent automates interaction with COBOL-based mainframe systems to manage bed registries in state-run mental health hospitals, tracking availability, updating admissions and discharges, and syncing with modern referral systems (e.g., crisp).
•    Demo video requirements: show agent querying mock mainframe for bed availability, updating discharge, and syncing with crisp referral system.
•    Technical details: on-premises; integrates with mainframes, crisp; HIPAA -compliant.
38. RPA for mental health billing and claims submission
•    Description: RPA bot automates billing and Medicaid claims submission for mental health services, validating procedure codes, submitting to MMIS, and reconciling payments to reduce denials.
•    Demo video requirements: show bot validating mock therapy claim, submitting to MMIS, and reconciling payment.
•    Technical details: on-premises; integrates with EHRs, MMIS; HIPAA -compliant.
39. AI risk assessment agent for mental health patients
•    Description: AI agent assesses suicide risk or violent behavior in mental health patients by analyzing EHR data, staff notes, and patient interactions. 
•    Provides real-time risk scores and alerts clinicians for intervention.
•    Demo video requirements: show agent analyzing mock patient data, calculating high suicide risk score, and alerting clinician.
•    Technical details: on-premises; integrates with EHRs, crisis management systems; HIPAA compliant; uses machine learning models.
40. mainframe-to-modern EHR integration agent
•    Description: AI agent automates data transfer from COBOL-based mainframe systems (e.g., legacy patient records) to modern EHRs in mental health hospitals, mapping data fields and ensuring compliance with interoperability standards.
•    Demo video requirements: show agent extracting mock patient record from mainframe, mapping to EHR, and confirming FHIR compliance.
•    Technical details: on-premises; integrates with mainframes, EHRs (e.g., epic); HIPAA compliant.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: July 25, 2025