Medicaid Management Information System (MMIS)

The legacy MMIS, implemented in 2017, is the foundation for eight of the modules that will be implemented in the CMES ecosystem. HCPF selected each vendor to provide modern and interoperable capabilities to HCPF members, providers, stakeholders, and staff.

What is staying the same?

Gainwell will continue to be the vendor for the Core MMIS (interChange and Fiscal Agent Operations) Claims Editing Solution, TPL, and CMS Interoperability and Patient Access modules.  

The Care and Case Management (CCM) and Electronic Visit Verification (EVV) modules will be transitioning from Gainwell to AssureCare and Sandata, respectively. These vendors are currently the subcontractors for these systems.  Subcontractors are separate companies that are contracted with the core vendor to provide a specialized service. By contracting directly with the subcontractor, we minimize disruption to users and improve operational efficiencies.    

What is changing?

• Edifecs was awarded the Electronic Data Interchange (EDI) contract and will implement their pre-built, already-tested solution so minimal development is required (known as COTS, or commercial off the shelf system).  As the new EDI vendor, Edifecs will integrate standardized tools, self-service testing and other improvements to the existing EDI processes and platform.
• Optum was awarded the Provider Call Center contract and is committed to ensuring consistent Provider customer support across the CMES. As the new Provider Call Center vendor, Optum will introduce technology to enhance self-service capabilities and improve voice and web chat functionality to operationalize self-efficiencies for providers. 

MMIS Modules

More information about each transition will be updated soon. The table below provides an overview of the MMIS modules and their anticipated changes.

Send questions or comments to hcpf_cmes@state.co.us.