Electronic Visit Verification Services

The Vendor is required to provide and manage an electronic visit verification (“EVV”) system to electronically track medicaid personal care services (“PCS”) and home health care services (“HHCS”) provided to medicaid members.
- Provider solution, an Enterprise Data Warehouse (EDW) and Decision Support System (DSS), and a Pharmacy Benefits Administrator (PBA).  
- Administer the State’s Medicaid program for enrolling and reimbursing health care providers for providing services to approximately three hundred and forty thousand (340,000) Medicaid eligible members.
- The next generation of the Medicaid Management Information System (MMIS) will be an enterprise solution that supports CMS’ modularity guidance with the following objectives:
•    Automate business processes wherever possible.
•    Includes standardized and automated electronic communications, data exchange capabilities, and easily integrates with other systems to enable enterprise-wide program management.
•    Complies with applicable federal and state policy.
•    Adapts quickly to the dynamic, evolving needs of existing programs and supports new regulations, policies, and innovations using business driven technical solutions.
•    Provides centralized access to data and data analytics tools.
- Provide an Electronic Visit Verification (EVV) solution that captures and verifies data with respect to personal care services and home healthcare services, including:
•    Type of service performed;
•    Individual receiving the service;
•    Date of service;
•    GPS verifiable location of service delivery;
•    Individual providing the service; and
•    Time the service begins and ends and is GPS verifiable.
- Must ensure each visit initiated is captured within the EVV Module, whether or not the visit was verified.
- Must ensure the daily batch processing activities are completed by 6:00 AM Mountain Time the following day.
- Must ensure all maintenance, upgrades, and enhancements to their module solution are implemented by the deadlines coordinated with agency.
- Must provide the necessary resources to support 24/7 system availability for data transfers, exchanges, and updates, in real-time or batch modes.
- Must use agency-approved automated tracking tool(s) to document software discrepancies, performance issues, and operational issues?
- Must ensure their solution is available to support processing and other Medicaid functions ninety-nine-point-nine percent (99.9%) of the time.
- Must conduct technical reviews of deliverables with agency to verify the content, identify, document, and resolve any issues or questions, and facilitate the acceptance process.
- Solution must support retrieval and presentation of data associated with geographic indicators such as; by state, by county, by zip code, by peer group, or by other geographical indicators specified by the Agency.
- Must collaborate with the Systems Integrator and agency on the development of an Operational Readiness Report that certifies the module, its subsystems, functions, data processes, operational procedures, staffing, telecommunications, and all other associated support are in place and ready thirty (30) business days prior to go-live.

- Contract Period/Term: 1 year
- Pre-Proposal Meeting Date: September 12, 2025
- Questions/Inquires Deadline: September 19, 2025