The Tennessee Department of Finance and Administration Division of TennCare may have a requirement for Medicaid Non-Emergency Medical Transportation (NEMT) Credentialing, Auditing, and Complaint Management Solution.

This information was obtained from the RFI document, which is attached in the Related Documents section. An updated background may be issued once a formal solicitation has been issued:

The State of Tennessee, Division of TennCare (TennCare), Office of Contract Management (OCM) issues this Request f or Information (RFI) to identify all available market solutions utilizing blockchain technology to perform online credentialing, auditing, and complaint management of the Medicaid Non-Emergency Medical Transportation (NEMT) benefit. TennCare is seeking information and insight from vendors with an existing commercial-offthe-shelf (COTS), sof tware-as-a-service (SaaS), or platf orm-as-a-service (PaaS) solution. This information may aid in organizing requirements for a formal procurement. TennCare appreciates all input and participation in this process.

This RFI is intended to identify existing commercial-off-the-shelf (COTS), software-as-a-service (SaaS), or platform-as-a-service (PaaS) solutions in the market that meet the following needs:

• Provide a web-based platform that employs blockchain technology to include a credentials repository, an audit tool capable of measuring compliance in real-time, and a complaint intake, referral, and management system for transportation providers, transportation brokers, and MCOs
• Establish a collaborative credentialing network among NEMT transportation providers (TPs), NEMT brokers, managed care organizations (MCOs), and TennCare
• Standardize unique NEMT transportation provider, NEMT transportation broker, managed care organization and TennCare credential taxonomies
• Provide blockchain infrastructure to establish provenance of all credentials, render them immutable, and permanently traceable
• Utilize blockchain technology to establish credential chain-of-custody and primary source verification
• Facilitate web access and secure online transmission of credentials between NEMT transportation providers, NEMT transportation brokers, managed care organizations, and TennCare
• Create an approach for converting historic and future credentials into electronic records.
• Provide a platform that offers tools to set and/or change the audit criteria, to perform real-time compliance checks, to automate auditing processes and to receive, triage, escalate, and monitor trends of complaints received against NEMT transportation providers, NEMT transportation brokers, or managed care organizations.
• Ensure credentialing processes and infrastructure support national accreditation standards by the Non-Emergency Medical Transportation Accreditation Commission (NEMTAC)
• Ensure technology tools meet CMS and healthcare security standards
• Provide credentialing, technical, and customer support services to ensure NEMT transportation provider, NEMT transportation broker, managed care organization, and TennCare access to help desk and troubleshooting issues with the platform

This RFI is intended to identify available commercial-off-the-shelf (COTS), software-as-a-service (SaaS), or platform-as-a-service (PaaS) solutions currently in the market that employ blockchain technology and offer the following functionality:

• Centralized credentials repository
• Centralized document repository
• NEMT provider credentialing review and approval workflow
• NEMT audit review and approval workflow
• NEMT complaint management review and approval workflow
• Functionality to facilitate real-time audit of documents and credentials of the NEMT drivers, Transportation Providers, NEMT Transportation Brokers, Managed Care Organizations, and state Medicaid agency’s NEMT program
• Functionality to facilitate flags and alerts to fight NEMT provider fraud, waste, and abuse
• Functionality to facilitate intake, triage, referral, and escalation workflows to manage TennCare member complaints against NEMT drivers, NEMT transportation providers, NEMT Transportation Brokers, and TennCare’s MCOs, and the state Medicaid agency’s NEMT program
• Reports functionality

The State of Tennessee’s Medicaid program provides health care for approximately 1. 4 million Tennesseans. Non-Emergency Medical Transportation (NEMT) is a Medicaid benefit that supports the overall health and wellness of beneficiaries by providing transportation to individuals that require assistance getting to and from healthcare services and other locations where services are provided that support the beneficiary’s wellbeing.

TennCare maintains partnerships with WellPoint, BlueCross / BlueShield of Tennessee, and United Healthcare to administer Medicaid NEMT services in the State. These Managed Care Organizations (MCO) utilize Verida and Tennessee Carriers for broker services that include management of over 125 transportation providers (TP) and coordination of service delivery to communities across the State. Together, these organizations constitute a team responsible f or safe and effective Medicaid NEMT service delivery in Tennessee. To ensure safe and effective NEMT services, these organizations complete a compliance process designed to set minimum standard s and to hold all stakeholders responsible for maintaining high-quality operations.

One component of this compliance process is credentialing. NEMT credentialing consists of the collection, review, and audit of credentials that represent the qualifications of transportation providers, drivers, and vehicles utilized to render NEMT services. Some examples of credentials include drivers’ licenses, driver training certificates, background checks, drug screenings, motor vehicle records, business licenses, vehicle registrations, vehicle inspections, insurance coverage, and sanctions and exclusions checks.

Transportations Providers are responsible f or compiling credentials that fulfill the requirements outlined in their contracts with brokers. These credentials are submitted to brokers who are responsible for reviewing them for completeness and accuracy. In turn, MCOs and TennCare manage compliance by auditing the credentials maintained by brokers. The credentialing process is repeated on a yearly basis and credentials must be verified and any expiration of credentials or violations of credentialing requirements must be addressed. This process is designed to ensure that the driver, vehicle, and support team for every NEMT ride delivered in Tennessee meets the competency and safety standards deemed necessary to protect beneficiaries and minimize opportunities for fraud, waste, and abuse of Medicaid benefits.

Another component of TennCare’s compliance process is auditing. NEMT auditing includes TennCare, its MCOs, and their NEMT Brokers accessing credentials and other NEMT documentation to evaluate if the NEMT transportation providers, NEMT transportation brokers, or MCOs are complying with federal and state NEMT program requirements; or if there are g aps in the credentialing or oversight of NEMT services that should be examined further. Auditing of NEMT services includes but is not limited to the following components:

• Validating that NEMT transportation providers possess valid driver’s license, vehicle registration, and insurance
• Validating that NEMT transportation providers were subject to criminal history background and sex offender registry checks
• Validating the authenticity of credentials submitted by NEMT transportation providers to ensure that information is not missing, erroneous, or fraudulent
• Evaluating NEMT transportation broker oversight of its NEMT transportation providers including compliance with NEMT program requirements and demonstrating professional conduct with regards to the TennCare member experience
• Evaluating MCO oversight of the NEMT transportation broker to validate that reported data was accurate, to validate that NEMT transportation brokers are maintaining effective trip logs and medical needs forms related to Medicaid covered services, to validate that there is accountability f or missed performance measures, and to ensure that TennCare member complaints are addressed
• Evaluate the MCOs to determine if proper Medicaid payments were made f or NEMT services and that the MCO is continuously management NEMT driver performance and credentialing to assure safe and effective Medicaid NEMT service delivery in Tennessee.

Another component of TennCare’s compliance process is complaint management which includes complaint intake, triage, referral, and response. NEMT complaint management includes each NEMT transportation broker hosting and maintaining an integrated case management system (CMS), that is typically a web-based platform. The CMS includes the date and time the complaint was submitted, the method of submittal, a detailed description of the nature of the complaint, and whether the complainant has selected the option for follow-up conversation. If requested by the complainant, the summary will be anonymous as to the identity of the complainant. The NEMT transportation brokers’ system tracks initial complaints and any subsequent follow-up contact with complainants on the same case. The system allows for a designation of a complaint category/case type and assigns specific cases to other users within the system for investigation.

The NEMT transportation broker’s complaint management system also typically has auto-case assignment capabilities based on incident types and/or locations so that the system is sending email notifications when cases are assigned. The NEMT transportation broker’s complaint management system provides f or the storage of the complaint and investigation data in accordance with Tennessee record retention requirements.

The NEMT transportation broker’s complaint management system facilitates communication between management and complaint intake representatives regarding specific cases, including providing templates and/or scripts for follow-up information and questions to be shared with the complainants by the intake representative. The NEMT transportation broker’s complaint management system includes the ability to reflect the status of a particular case, at a minimum allowing the case to be reflected as open, in progress or closed.

The NEMT transportation broker’s complaint management system allows for the creation and downloading of reports both manually and as scheduled intervals at minimum levels of monthly, quarterly, annually, and year-to-date program activity including the nature of the complaint, the length of time from initial complaint intake to case closed, and the department reference.

TennCare is seeking a solution that would be open-system allowing for application programming interface between the NEMT transportation broker’s information system and this credentialing, auditing, and complaint management solution or offer the ability for the NEMT transportation broker to use the credentialing, auditing, and complaint management solution for all of its complaint tracking and management needs.

TennCare’s Office of Contract Management(OCM) sits within TennCare’s Division of Managed Care Operations and is responsible for the compliance oversight of TennCare’s NEMT benefit. OCM collaborates with the MCOs and the NEMT transportation brokers to protect the financial integrity and high-quality service delivery of TennCare’s NEMT program. OCM has current processes in place to facilitate the oversight of the NEMT benefit, but OCM does not possess electronic credentialing, sophisticated analytics, or aggregator complaint case management tools to enable the enhancements and improvements TennCare is seeking. OCM’s objective is to provide TennCare’s NEMT program with solutions that can drive improvements in proper NEMT utilization, improved member experience, and cost-effective use of the TennCare’s NEMT benefit.

EXPLANATION OF VENDOR SOLUTION AND RELEVANT EXPERIENCE

*Please limit your section 9 response to five (5) pages

Please provide a summary statement regarding how your solution for a non-emergency medical transportation (NEMT) online credentialing, auditing, and complaint management system employs blockchain technology that can help TennCare achieve its goals articulated within section 1. STATEMENT OF PURPOSE.

The following items are regarding your relevant experience in providing a non-emergency medical transportation (NEMT) online credentialing, auditing, and complaint management system that employs blockchain technology within the last five (5) years. In response to the requests below, please distinguish between Medicaid and Non-Medicaid experience. Please also distinguish between post-pay analytics and pre-pay analytics in any examples you provide. For your response, please do the following:

List the total number of experiences where your solution for a non-emergency medical transportation (NEMT)online credentialing, auditing, and complaint management system that employs blockchain technology was deployed for the five (5) year period (may include contracts that began prior to 5 years ago but continued within the last 5 years). Of that total, please elaborate the following the following:

• Number of instances related to Medicaid versus Non-Medicaid
• Number of instances which included an online credentialing solution involving blockchain technology for NEMT.
• Number of instances which included an online, real-time auditing solution for NEMT.
• Number of instances which included a case management information system for beneficiary complaint intake, triage, referral, and reporting for NEMT.

Describe three (3) distinct experiences where you delivered NEMT provider credentialing involving blockchain technology, audit services, and complaint management services or are currently delivering these services. For each, please distinguish between Medicaid and Non-Medicaid, as well as which of the requested services are relevant (credentialing using blockchain technology, audit services, and/or complaint management services). Please make clear what stage of the project you’re in (e.g. pre-implementation, post- implementation, etc.)at the time of this RFI response.

If delivery is for a government agency, please include the following information:

• State/Federal Agency Name
• Contract Start/End Dates
• Contract Value
• Summary of scope that also specifies non-emergency medical transportation (NEMT) online credentialing, auditing, and complaint monitoring system that employs blockchain technology solutions

If f or a commercial entity, please provide similar information to the degree it is contractually appropriate to share. Client names and other identification-related details may be omitted; however, we expect that you can, at minimum, explain the relevance of the scope of work to our objectives.

TECHNICAL SPECIFICATIONS ANDREQUIREMENTS

*Please limit your section 10 response to seventy-five (75) pages

Credentialing Process and Data Considerations

Describe what constitutes a “credential” within your solution.

Describe how your solution digitizes the credential

Describe how your solution’s approach to digitizing the credential is scalable, specifically whether there are discreet data points, artifacts, an ability to upload, and the ability for your solution to receive data feeds from primary sources?

Describe how your solution can distinguish between acceptable documentation (scanned image or received message) versus a credential?

What endorsements are associated with the “credential”within your solution? Are the users of your solution able to selectthe criteria behind the credential and modify the criteria at will? Or are the criteria behind the credential pre-defined and/or off-theshelf (OTS)?

Describe how your solution allows users of the solution (e.g. organizations such as TennCare, its Managed Care Organizations, its NEMT Brokers, and Transportation Providers) to move the “credential” between organizations.

Describe your solution’s approach to ownership of the data. How does each user (e.g. organizations such as TennCare, its Managed Care Organizations, its NEMT Brokers, and Transportation Providers) own the data? Who owns copies of the data? Is there a shared function? Is there an interface available between organizations’ systems and your solution? How does your solution handle transition of users (e.g. organizations such as TennCare, its Managed Care Organizations, its NEMT Brokers, and Transportation Providers) and their data within your solution when these users join your solution as new users or leave your solution and need to be deprovisioned due to the users no longer serving as a Managed Care Organization, NEMT Broker, or Transportation Provider with TennCare?

Describe your solution’s approach to centrally storing credentials. Outline your solution’s architecture. Are the credentials stored in the cloud or on physical servers? What is your solution’s data storage capacity and limitations?

Describe your previous experience with establishing a collaborative network of Non Emergency Medical Transportation (NEMT) providers, including transportation providers, transportation brokers, managed care organizations, and state government agencies.

What are the steps involved and the estimated ramp up time to get NEMT transportation providers, NEMTBrokers, Managed Care Organizations, and state Medicaid Agencies provisioned as users and able to use the solution?

It is expected that the solution will be using, at minimum, Transportation Provider data, NEMT Broker data, MCOdata, and State Medicaid Agency data. Please confirm whether the solution envisioned for TennCare has been used previously to conduct credentialing across all of these stakeholders.

Does your solution have built in user roles and are mapped to specific sets of application functionality? Please explain the assumed business roles or how roles and responsibilities are defined for a client.

To access relevant TennCare data, a vendor may be granted access to source data within TennCare’s information systems or other data storage applications. Please explain solution capabilities for extracting data files for use in your systems.

Does the solution process and integrate unstructured data, i.e. web data, notes, and/or call center calls? Please briefly summarize any key considerations related to this, including what has been done for previous clients.

Please summarize your deployment options and data hosting capabilities, e.g. on-site, hosted, web portal, or cloud based. Please comment on the readiness of your secure environment, e.g. a cloud environment, where data accessed/provided can be stored throughout the implementation. Please briefly summarize any key considerations and recommendations related to this. Please specify the platform e.g., Amazon Web Services Cloud or Microsoft Azure Cloud.

Does your recommended solution meet security and compliance standards. If so, please describe specific examples of the compliance standards relevant to Managed Care Contractor and State data.

Please summarizes any additional third-party certifications or standards met by your solution that may be relevant to the scope of work.

For the full list of tentative requirements, please see the RFI document attached in the Related Documents section. Requirements may change upon the release of formal solicitation.