Florida Medicaid Management Information System Takeover and Modernization

Background
The State of Florida, Agency for Health Care Administration (AHCA) is issuing this Request for Information (RFI) to gather industry insights on services that support the Florida Medicaid Management Information System (FMMIS). This initiative is part of a broader effort to modernize and transform the Florida Medicaid Enterprise, which includes complex systems for claims processing, data management, and service delivery. The goal is to enhance interoperability and improve healthcare administration in line with the Centers for Medicare and Medicaid Services’ (CMS) guidelines.

Work Details
The RFI seeks input on the transition and modernization of the FMMIS into a standalone module capable of:

- Adjudicating Fee-for-Service (FFS) claims for Medicaid reimbursement;
- Processing managed care encounter claims;
- Supporting all Medicaid financial activities including capitation payments;
- Managing claims receipt, adjudication, editing, pricing, disbursement of funds, and reporting across various service types;
- Ensuring real-time processing of FFS claims;
- Supporting diverse reimbursement methodologies;
- Tracking claims processing activities;
- Maintaining recipient eligibility and benefit plan assignments;
- Processing MCO enrollments;
- Handling Electronic Data Interchange (EDI) transactions with enhanced validation; and
- Integrating with existing systems while ensuring compliance with security standards.

Period of Performance
The current contract for operations and maintenance of FMMIS expires on December 31, 2027. The RFI responses are due by May 1, 2025.

Place of Performance
The services will be performed in Florida as part of the state's healthcare administration efforts.

Bidder Requirements
Respondents should have direct experience with Medicaid fiscal agent systems and operations. They are encouraged to provide innovative ideas and best practices related to modular transition, operations maintenance, and modernization of legacy MMIS systems.