Upcoming Procurements

Estimated Release Dates provided are based on calendar year and are subject to change.

Patient Centered Medical Home Recognition Program (PCMH)

  • Procurement Number: RFP 31865-00665
  • Projected Release Date: 2nd Quarter 2026
  • Summary:

The State of Tennessee, Division of TennCare (TennCare), Chief Medical Office is seeking a Contractor to implement a rigorous accreditation process for primary care organizations in the Patient Centered Medical Home (PCMH) Model. The Contractor will be expected to:

  • Maintain a set of precise standards for defining patient-centered care as it pertains to the PCMH Model and leverage these standards as the guiding framework for all activities related to the accreditation process;
  • Onboard new TennCare PCMH providers and guide them through obtaining PCMH Recognition through the contractor’s established PCMH Recognition program;
  • Guide current providers and their 450+ PCMH sites through the annual renewal of their PCMH Recognition;
  • Provide TennCare with detailed monthly project reports outlining assistance given to PCMH providers’ and their sites and updating TennCare with the status of ongoing PCMH Recognition efforts;
  • Develop, operationalize and provide access to a dashboard for TennCare to track providers’ sites in their progress of initially obtaining and then annually renewing PCMH Recognition; and
    • Designate key personnel to deliver the above services, such as a project manager to regularly report on progress to TennCare, a representative to answer provider questions about application processing, and a qualified team of evaluators for the PCMH Model. 

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation PCMH. You may request this form from the Solicitation Coordinator at Sharon.D.Way@tn.gov

SOLICITATION NOTICE

August 12, 2025

Service Providers:

The State of Tennessee is issuing a solicitation to provide Statewide Advocacy and Outreach Services for TennCare Applicants and Members to the State.

Please note the following solicitation highlights:

  • Solicitation I.D. # RFA 31865-00917
  • Scope of Goods or Service Statewide Advocacy and Outreach Services for TennCare Applicants and Members
  • Procuring State Agency Department of Finance and Administration, Division of TennCare
  • Response Deadline Friday, October 3, 2025
  • Solicitation Coordinator Sharon Way – 615.339.1741 – Sharon.D.Way@tn.gov

This solicitation is unique in that it has been identified by the Department of Finance and Administration, Strategic Technology Solutions as containing information that is confidential under Tenn. Code Ann. § 10-7-504(i). Therefore, a non-disclosure agreement must be signed before the solicitation details may be disclosed by the State.

If you are interested in responding to this solicitation, please complete the attached non-disclosure agreement and return it to the Solicitation Coordinator. The above solicitation includes a document on “How to Register to do Business with the State of Tennessee.” Please note that it can take approximately 10-14 days to become registered. We appreciate your interest in doing business with the State of Tennessee and hope that you will consider responding to this solicitation.

Statewide Outreach RFA NDA 31865-00917

Program for All-Inclusive Care for the Elderly (PACE)

  • Procurement Number: RFA 31865-00918
  • Release Date: 4th Quarter 2025
  • Summary:

Pursuant to Public Chapter 502, effective May 21, 2025, the purpose of this Request for Application is to establish a PACE program in the West or Middle Tennessee region as required by the legislation. A PACE program is a program of all-inclusive care for elderly persons that provides comprehensive, integrated acute and long-term care services for frail, elderly dual-eligible individuals who require the level of care provided in a nursing facility and who meet eligibility criteria established by the federal Centers for Medicare and Medicaid Services (CMS). A new PACE program would have a specific defined service area, including specific zip codes and a service area map, with a site location for the PACE center centrally located within that service area. The program is the single source of Medicaid and Medicare benefits for PACE participants and must meet all relevant federal and state requirements.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation PACE. You may request this form from the Solicitation Coordinator at Sharon.D.Way@tn.gov

MEDICAID MANAGEMENT INFORMATION SYSTEM (MMIS)

  • Procurement Number: 31865-00662
  • Projected Release Date: 3rd Quarter 2026
  • Summary:
  • TennCare seeks a Contractor with the qualifications and experience necessary to assume, operate, migrate to the cloud, and enhance TennCare’s Medicaid Management Information System (MMIS).
  • TennCare's MMIS solution is used to administer and manage Enrollment in Medicaid Managed Care Organizations (MCOs), as well as capture claims and encounter data from the MCOs. TennCare seeks enhancements to existing capabilities, including but not limited to:
  • Member Enrollment: Automate the assignment and enrollment of Members to Managed Care Contractors (MCCs) based on the application of eligibility data to TennCare business rules and policies.
  • Financial Management: Support the centralized management and oversight of TennCare’s financial accounting, payments, receivables/recoveries, reconciliation, budget management, and financial reporting activities across the enterprise.
  • Encounter Processing: Support the centralized management of Encounter data received from MCCs or a third-party adjudicator, including receipt and processing of encounter data, and applying edits and audits based on TennCare’s business rules.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation MMIS associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Medical Appeals

  • Procurement Number: 31865-00659
  • Procurement Release Date: 4th Quarter 2025
  • Summary:

The Division of TennCare requires the services of a URAC-accredited Independent Review Organization for the provision of independent medical necessity reviews, and expert medical opinion testimony related to (1) TennCare and CoverKids member benefit appeals, (2) TennCare and CoverKids member requests to change their managed care organization (“MCO”) assignment outside of the annual change period, and (3) MCO provider appeals involving claims disputes.

Every TennCare member has the right to appeal an adverse determination (where a medical, dental, or pharmaceutical benefit was denied, reduced, or terminated.) When the denial is due to the MCC determining the service requested is not medically necessary, the Contractor provides an unbiased, third-party review and expert opinion. The right to an appeal is required by CMS and there are associated timelines which the Medicaid agency must abide by. Without the contract, TennCare could not proceed with medical member appeal process.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Medical Appeals associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Workforce Registry

  • Procurement Number: 31865-00658
  • Projected Release Date: 4th Quarter 2025
  • Summary:

The State of Tennessee, Division of TennCare Long Term Services and Supports (LTSS) is seeking competitive bids to join and establish a Contract with an existing web-based direct care/support employer registry system (“Workforce Registry”). The Workforce Registry would serve multiple purposes, including but not limited to: a direct care/support employer registry, reporting capabilities, and a learning management and resource library. It will also provide a job matching portal specific to direct care/support positions for Home and Community Based Services.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Workforce Registry associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Provider Services Solution (PRDS)

  • Procurement Number: 31865-00652
  • Release Date: September 2, 2025
  • Summary:

TennCare seeks to select a contractor that will successfully implement a Provider Services Solution, with optional services for Enrollment Specialists, Call Center Support, and Site Visit Support for the State. The Solution will serve as the system of record for TennCare Provider Registration/Enrollment data, and should meet the following at a minimum:​ ​

- Use automated screening and monitoring processes and tools to verify provider enrollment and eligibility based on Federal requirements contained in 42 CFR 455.436

- Meets the requirements set forth in Tenn. Code Ann. (TCA) § 56-7-1009 regarding health care provider credentialing applications from the Council on Affordable Quality Healthcare (CAQH)

- Improve provider data quality through seamless integration with CAQH ProView

- Reduce the administrative burden of Medicaid providers

- Improve provider-related business process efficiencies and data accuracy using configurable business rules, modernized technologies and practices​

- Improve the provider data reporting capabilities between TennCare and CMS

- Reduce the manual effort and administrative burden to TennCare through integration, automation​, and reporting

- Successfully attain CMS Certification

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Provider Services Solution associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Enterprise Testing Services

  • Procurement Number: 31865-00651
  • Projected Release Date: 4th Quarter 2025
  • Summary:

TennCare seeks to select a Contractor to centralize User-Acceptance (UAT) testing services in support of TennCare business units. The selected Contractor will support and oversee user acceptance testing (UAT) activities across TennCare MMIS modules and business applications. The Contractor will be responsible for providing testing resources and services to support quality assurance activities for the release of new applications/modules and enhancements to operational applications/modules that will include test script creation and review, test execution, incident reporting and defect re-testing, and test automation support for UAT and Operation & Maintenance phases. The Contractor is expected to provide appropriately skilled and experienced testing resources (i.e., Manual/Functional testers, UAT Script Development Leads/Business Analysts, Technical Testers (ETL/Batch testing), and potentially Automation Engineers) for each applicable business unit with the goal of improving testing rigor and the overalhor.tn.gov/sites.html/contl quality of work completed. This transformation to a centralized enterprise capability will serve to modernize the future of TennCare User Acceptance Testing (UAT) by improving the quality of existing manual UAT collateral, and with a strong emphasis on minimizing manual regression testing and increasing test automation.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Enterprise Testing Services associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

TENNESSEE ELIGIBILITY DETERMINATION SYSTEM (TEDS)

  • Procurement Number: 31865-00648
  • Projected Release Date: 4th Quarter 2025
  • Summary:

TennCare seeks a Contractor with the qualifications and experience necessary to assume, operate, and enhance TennCare’s Tennessee Eligibility Determination System (TEDS). The TEDS platform includes data collection, application registration, eligibility determination and appeals, and correspondence functionality for applicants and members to Tennessee Medicaid and/or Children’s Health Insurance Program (CHIP), Pre-Admission Evaluations and Referrals for Long Term Services and Support (PERLSS), and Medical Appeals Tracking System (MATS) for medical services. It also includes member-facing and partner-facing portals and a mobile application.

TEDS is the TennCare solution that establishes and maintains eligibility for Medicaid and CHIP.

PERLSS is the TennCare Long-Term Services and Supports (LTSS) solution that manages and tracks medical evaluations to determine enrollment in several Long-Term Services and Supports programs.

MATS is the TennCare Medical Appeal Tracking System used to manage Member medical services appeals

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation TEP associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Pharmacy Benefits Administrator (PBA)

  • Procurement Number: 31865-00654
  • Projected Release Date: 4th Quarter 2025
  • Summary:

The State of Tennessee, Department of Finance and Administration, Division of TennCare administers the TennCare Pharmacy Medicaid Program pursuant to a waiver (State Plan) from the Centers for Medicare and Medicaid Services (CMS). In addition, TennCare administers two commercial pharmacy programs, CoverRx and CoverKids. These three programs are collectively referred to herein as the “TennCare Pharmacy Programs” or “Programs”. The TennCare Pharmacy Programs offer prescription drug benefits to approximately 1.5 million members and contract with a third-party service organization, a Pharmacy Benefits Administrator (PBA), to manage prescription drug benefits on their behalf. The PBA offers a variety of services, including but not limited to claim adjudications, customer service call centers, clinical services such as prior authorizations, drug utilization reviews, rebate administration, and mail-order pharmacy. Although the TennCare Pharmacy Programs outsource these services to the PBM, the Programs remain responsible for the compliance and accuracy of the services the PBM performs pursuant to the following controls: PBM contract with TennCare, State Plan Amendment, rules and regulations, and Centers for Medicare and Medicaid Services (CMS) federal guidance and requirements.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation PBA associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

Care Coordination Tool (CCT)

  • Procurement Number: 31865-00653
  • Projected Release Date: 4th Quarter 2025
  • Summary:

The Care Coordination Tool (CCT) will be a cloud-based population health management technology platform for healthcare providers to improve care delivery of their TennCare members. The CCT will help stratify the clinical risk of attributed members, aggregate clinical data to identify care gaps, provide insight into quality metrics, and identify care coordination activities to aid in quality improvement. The CCT will also share data feeds including real time Admissions, Discharge, and Transfer (ADT) feeds from hospitals and display attribution so that providers can easily see which TennCare members are assigned to them and identify opportunities for improved transitions of care. This tool will also integrate with the TennCare health plan provider portals to allow providers to perform certain programmatic functions within the tool.

The primary users of the CCT will be TennCare providers enrolled in two of the state’s value-based payment programs, Patient Centered Medical Home and Tennessee Health Link. Patient Centered Medical Home is the state’s primary care value-based program aimed at improving quality and cost of care for TennCare members. Tennessee Health Link providers deliver care coordination for TennCare members with the highest behavioral health needs. You can find more information about the programs on the Primary Care Transformation web page.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation CCT, associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

TennCare Connect Contact Center Solution (TCCCS)

  • Procurement Number: 31865-00663
  • Release Date: 4th Quarter 2025
  • Summary:

TennCare seeks a Contractor that shall provide the staff, facility, and technology for the management of a TennCare Member Services Contact Center. The Contractor shall provide a Contact Center solution (hereinafter referred to as “TennCare Connect” or “Contact Center”) to support TennCare and CoverKids eligibility services for individuals seeking to obtain, update, and maintain eligibility. The Division of TennCare (“TennCare”) is the single state agency designated by the State and the Centers for Medicare and Medicaid Services (CMS) to administer the federal Medicaid program pursuant to Title XIX of the Social Security Act (42 U.S.C § 1396 et seq.) and the Section 1115 demonstration waiver granted to the State and any successor programs by CMS. TennCare also administers the federal Social Security Act Title XXI Children’s Health Insurance Program (CHIP), known as “CoverKids” in Tennessee.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Member Services Contact Center associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible.

IT Audit Management

  • Procurement Number: 31865-00661
  • Release Date: 4th Quarter 2025
  • Summary:

TennCare seeks a contractor to provide IT audit services. The contractor shall provide dedicated staff with proven audit work experience, specifically in security and privacy as defined by NIST 800-53, to work under the direction of TennCare Audit Management to perform assessments of organizational systems and assess compliance with federal and state government standards. It should be noted the staff provided would not be performing hands on technical testing (e.g., vulnerability scans, penetration testing; however, staff should be able to examine, understand, and assess potential impacts of the results is required.

By providing staff to support TennCare Audit and Investigations team members, the contractor shall execute the following deliverables:

  • Develop a strong understanding of TennCare business practices and IT system processes by completing all onboarding identified by TennCare.
  • Evaluate security and privacy controls to ensure they are designed appropriately, implemented correctly, operating as intended, and producing the desired outcome with respect to meeting the security requirements for the system.
  • Identify multiple documents and artifacts, synthesize information and processes, and effectively summarize their content as well as apply said information to the security and privacy controls being assessed.
  • Research and identify methods and objects that will be used to validate complex implementations. These methods may be standardized and non-standardized.
  • Identify personnel or the role(s) that is responsible for the implementation of each privacy and security control to conduct interviews. Build relationships to effectively communicate with business and technical subject matter experts (SMEs) in order to determine and gather appropriate evidence needed to validate compliance and mitigate risk.
  • Complete the review and the evaluation of assigned security and privacy controls within stated timelines to ensure timely reporting to CMS.
  • Determine risk exposure (operational, financial, reputational, systems), and develop remediation strategies
  • Support the State’s Audit and Investigations department team members in the planning and execution of internal audit procedures and the creation of internal audit reports.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation IT Audit Management associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible

Analytic Support

  • Procurement Number: 31865-00664
  • Release Date: 4th Quarter 2025
  • Summary:

TennCare is seeking analytics consulting services to contribute 1) support for building general agency capacity in data analytics to make higher value use of our data, and 2) expertise to support state staff in the completion of specific high priority, high complexity analytic projects.

*Potential Respondents and interested parties must complete the TennCare Blackout Period Attestation Analytic Support associated with this RFP. The Attestation must be returned to the Solicitation Coordinator as soon as possible