Medicaid Management Information System (MMIS)
MMIS Background
The Colorado Medicaid MMIS System, also known as the Colorado interChange was implemented in March of 2017 and managed by Gainwell Technology.
MMIS Transition
HCPF is transitioning to a modular approach for managing its Colorado Medicaid Enterprise (CMES) ecosystem, where smaller contracts will focus on specific technical or operational functions.
The MMIS solution has been separated into eight modules.
Four of the modules were awarded to new vendors and will transition in 2025 and 2026.
The table below provides an overview of the MMIS modules and their anticipated changes.
| Module | Current Vendor | New Vendor | Go Live |
|---|---|---|---|
| Provider Call Center | Gainwell | Optum | Implemented May 2025 |
| Electronic Data Interchange | Gainwell | Edifecs | Phased Implementations starting 2025 |
Core MMIS | Gainwell | Gainwell | N/A |
Third Party Liability | Gainwell | Gainwell | N/A |
Claims Editing Solution | Gainwell | Gainwell | N/A |
CMS Interoperability and Patient Access | Gainwell | Gainwell | N/A |
Care and Case Management | Gainwell | AssureCare | N/A |
Electronic Visit Verification | Gainwell | Sandata | N/A |
What is changing?
Provider Services Call Center
On May 1, 2025, OptumInsight (Optum) became the Provider Services Call Center vendor.
As part of the transition, the changes below occurred:
- The Provider Services Call Center phone number changed.
- Optum assumed management of the Provider Services Call Center.
Gainwell continues as the vendor for the Colorado interChange and the Provider Web Portal.
This vendor change only applied to the Provider Services Call Center. The Care and Case Management (CCM), Dental, Pharmacy, Electronic Visit Verification (EVV) call centers did not change. For a complete list of assistance resources, visit the Provider Contacts web page.
In part of the transition, additional functional enhancements are active and in use:
- Post-call surveys to gather provider feedback and assess satisfaction levels.
- Virtual hold capability allows providers to receive a callback when an agent becomes available, significantly reducing (or even eliminating) wait times.
Electronic Data Interchange
Electronic Data Interchange (EDI) functionality, including batch processing and trading partner enrollment, will transition from the Medicaid Management Information System (MMIS) operated by Gainwell Technologies to a new EDI module operated by Cotiviti (formerly Edifecs). The new EDI transition is scheduled to be implemented in the late summer of 2026, with phased implementations starting in 2025.
The EDI module will provide a robust user-friendly, query-based solution that allows HCPF and Authorized Users to research X12 claims data more effectively and efficiently to resolve issues.
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.
Send questions or comments to hcpf_cmes@state.co.us.