The Colorado Medicaid Enterprise Solutions (CMES) ecosystem is comprised of the health information systems which operate the Health First Colorado (Colorado’s Medicaid program), Child Health Plan Plus (CHP+) and other health coverage programs for Coloradans who qualify. Each of these health information systems serve a critical role in the ecosystem that supports our Providers, Regional Accountability Entities (RAEs), counties, case managers, and other partners who provide quality care for our members.
Procurement activities for CMES modules will be completed by the Summer of 2024. A module is a functional business process or set of processes that are implemented using software, data, and interfaces. This procurement work ensures compliance with federal requirements and aligns with HCPF’s goals of continuity, modularity, integration and operational excellence.
The CMES is comprised of 16 modules:
- Care and Case Management
- Claims Editing Solution
- CMS Interoperability and Patient Access
- Core MMIS
- Electronic Data Interchange (EDI)
- Electronic Visit Verification
- Enterprise Data Warehouse
- Opioid Risk
- Pharmacy Benefit Management System
- Preferred Drug List
- Program Integrity
- Provider Call Center
- Real-Time Benefit Tool
- Rebate
- Recoveries Electronic Database (RED)
- Third Party Liability (TPL)
The Enterprise Solutions Integrator (ESI) is another important component of the CMES ecosystem. The ESI Division and its vendor, Ernst & Young, will oversee data integration activities across the CMES ecosystem.
For information about each module transition, use the navigation pane. This information will be updated as contracts are executed and system development progresses.
Send questions or comments to hcpf_cmes@state.co.us.