Nebraska Medicaid Program
Current Initiatives

MMIS Replacement Project

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NEWNebraska MMIS Replacement Procurement Information
Nebraska Medicaid has moved past the analysis stages and into the procurement of its MMIS Replacement Project. The project continues to support an innovative, modular, and phased approach. An informational document outlining several components of the project is available at the following: LINK

The Medicaid Management Information System (MMIS) is comprised of functionality within a number of systems that provide support for the administration of Nebraska’s Medicaid Program.  The MMIS processes claims, supports coordination of benefits, assists in surveillance and utilization review of claims payments, generates federal and management reporting, and provides case management tools.
The federal government certified the current MMIS in 1978 and, although it has satisfactorily met its original objectives, it has become increasingly difficult to maintain and enhance because of outdated technologies in the automated application. Efforts to enhance the system over the past decade have improved some of the Medicaid Program operations.
Recognizing the need to implement new technology, and with the support of the Legislature, DHHS has embarked upon a phased approach to replace the MMIS functionality.
MLTC has performed the strategic planning analysis necessary for a project of this size.  The strategic planning analysis included the review of potential alternatives and procurement strategies.  In the final analysis, MLTC determined that the Medicaid program would best be served by a Medicaid Enterprise modular approach to replace existing MMIS functionality.  Program decisions such as the formation of the new Heritage Health managed care program and future procurement of a dental benefit management plan impacted the approach for the MMIS replacement.  As DHHS was procuring an Enrollment Broker to manage enrollment for the Heritage Health program, DHHS decided that capitation processing was a logical inclusion in the enrollment broker scope.  Further, the expected volume reduction in fee-for-service claims led to the decision to move forward with utilizing one of the Heritage Health plans as a claims broker service (CBS) to process fee-for-service claims.  The top priority for the MMIS replacement project in support of the new programs is improving data management and analytics (DMA).  Therefore the project team is procuring a DMA contractor to implement and operate a new DMA solution.
MLTC intends to contract with external vendors to fulfill the components of this planned approach through the release of multiple requests for proposals (RFPs). The following RFP documents have been released:
·         RFP #5151Z1: The CBS was included in the Heritage Health procurement.  The CBS component was awarded to United Healthcare.
·         RFP #5190Z1: Capitation processing was included in the Enrollment Broker Services RFP. The contractor will support MCO and primary care provider (PCP) selection by Heritage Health enrollees and members as well as replace the MMIS capitation processing functionality. The Enrollment Broker contract was awarded to Automated Health Systems with a September 1, 2016 planned implementation.
·         RFP # 5330Z1:  The Data Management and Analytics (DMA) RFP was released June 1, 2016.  
·         RFP #5252Z1: Independent Verification and Validation (IV & V): was released on March 29, 2016.  The Notice of Intent to Award the contract to First Data Government Solutions was posted on July 21, 2016.
 All RFPs are published by the Nebraska Department of Administrative Services at For questions regarding the MMIS Replacement Planning Project, please send an e-mail to  Updated information will be shared as it becomes available.

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