RFP Sourcing Event - Provider Data Management_Credentialing Verification Office RFP

Location: North Carolina
Posted: Jun 12, 2026
Due: Aug 21, 2026
Agency: State Government of North Carolina
Type of Government: State & Local
Category:
  • R - Professional, Administrative and Management Support Services
Solicitation No: Doc2075995037
Publication URL: To access bid details, please log in.
Solicitation Number: Doc2075995037
Project Title: RFP Sourcing Event - Provider Data Management_Credentialing Verification Office RFP
Description: The Purpose of this Request for Proposal (RFP) is the for the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB or Department), to solicit offers for the acquisition for the Provider Data Management Credentialing Verification Organization (PDM/CVO). Medicaid Integrated Modular Solution (MIMS) NCDHHS is replacing the Department’s Medicaid Management Information System (MMIS) with a Medicaid Enterprise System (MES), also referred to as the Medicaid Integrated Modular Solution (MIMS). MIMS will be implemented through a multi-phase initiative, the MMIS Replacement Project. The MMIS Replacement Project will implement a series of interrelated modules. These modules will have functionality designated by the Centers for Medicare and Medicaid (CMS) in support of obtaining compliance with Medicaid Information Technology Architecture (MITA) 3.0 Framework and CMS certification for each module. The future PDM/CVO solution is envisioned as a centralized Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution that will support the Agency’s provider data management functions including data intake, data management, enrollment, credentialing, data sharing and data archiving throughout the provider life cycle. The solution will also meet National Committee for Quality Assurance (NCQA) standards and enhance provider credentialing through centralized CVO features that include a Credentialing Committee and delegated enrollment and credentialing. The PDM/CVO solution will consist of the below high-level items: Consolidate all provider data to reduce administrative redundancy for providers. Simplify enrollment, data maintenance and revalidation processes. Facilitate centralized credentialing on behalf of NCDHHS payers and health plans. Potentially mitigate reimbursement errors caused by outdated provider data. Allow for delegated enrollment and credentialing. Aligning North Carolina’s credentialing process with NCQA standards. Establish a representative centralized Credentialing Committee with representatives from NCDHHS payers and health plans. The NC MIMS system will modernize and transform North Carolina Medicaid and its sister divisions, including the Division of Mental Health (DMH) and Division of Public Health (DPH). NC MIMS will improve the Provider and Medicaid beneficiary experience across the enterprise.
Opening Date: 8/21/2026 2:00 PM
Posted Date: 6/12/2026
Status: Open
Department: DEPARTMENT OF HEALTH AND HUMAN SERVICES - DHHS
Solicitation Number
*
Doc2075995037
Department
DEPARTMENT OF HEALTH AND HUMAN SERVICES - DHHS
Status Reason
Open
Opening Date
2026-08-21T14:00:00.0000000
Posted Date
*
2026-06-12T14:30:43.0000000Z
Primary Commodity Code
Cloud-based software as a service
Mandatory Conference/Site Visit
—
—
Special Instructions
—
Solicitation Type
*
Select RFP IFB RFI
Owner
Tyler Ragor
Description
The Purpose of this Request for Proposal (RFP) is the for the North Carolina Department of Health and Human Services (NCDHHS), Division of Health Benefits (DHB or Department), to solicit offers for the acquisition for the Provider Data Management Credentialing Verification Organization (PDM/CVO). Medicaid Integrated Modular Solution (MIMS) NCDHHS is replacing the Department’s Medicaid Management Information System (MMIS) with a Medicaid Enterprise System (MES), also referred to as the Medicaid Integrated Modular Solution (MIMS). MIMS will be implemented through a multi-phase initiative, the MMIS Replacement Project. The MMIS Replacement Project will implement a series of interrelated modules. These modules will have functionality designated by the Centers for Medicare and Medicaid (CMS) in support of obtaining compliance with Medicaid Information Technology Architecture (MITA) 3.0 Framework and CMS certification for each module. The future PDM/CVO solution is envisioned as a centralized Provider Data Management/Credentialing Verification Organization (PDM/CVO) solution that will support the Agency’s provider data management functions including data intake, data management, enrollment, credentialing, data sharing and data archiving throughout the provider life cycle. The solution will also meet National Committee for Quality Assurance (NCQA) standards and enhance provider credentialing through centralized CVO features that include a Credentialing Committee and delegated enrollment and credentialing. The PDM/CVO solution will consist of the below high-level items: Consolidate all provider data to reduce administrative redundancy for providers. Simplify enrollment, data maintenance and revalidation processes. Facilitate centralized credentialing on behalf of NCDHHS payers and health plans. Potentially mitigate reimbursement errors caused by outdated provider data. Allow for delegated enrollment and credentialing. Aligning North Carolina’s credentialing process with NCQA standards. Establish a representative centralized Credentialing Committee with representatives from NCDHHS payers and health plans. The NC MIMS system will modernize and transform North Carolina Medicaid and its sister divisions, including the Division of Mental Health (DMH) and Division of Public Health (DPH). NC MIMS will improve the Provider and Medicaid beneficiary experience across the enterprise.

Attachment Preview

STATE OF NORTH CAROLINA
Department of Health and Human Services
Division of Health Benefits
Request for Proposal #30-2026-017-DHB
Provider Data Management Credentialing Verification Organization (PDM/CVO)
Page 1 of 351 RFP #30-2026-017-DHB

STATE OF NORTH CAROLINA
Request for Proposal
#30-2026-017-DHB
______________________________________________________
For internal State agency processing, please provide your company's Federal Employer Identification Number or alternate identification
number (e.g., Social Security Number). Pursuant to North Carolina General Statute 132-1.10(b) this identification number shall not be
released to the public. This page will be redacted before the procurement file is made available for public inspection.
This page is to be filled out and returned with your Proposal.
ID Number:
_____________________________________________________
Federal ID Number or Social Security Number
______________________________________________________
Offeror Name
Page 2 of 351 RFP #30-2026-017-DHB

STATE OF NORTH CAROLINA Department of Health and Human Services
Request for Proposal # 30-2026-017-DHB
Date RFP Issued/Posted: 6/12/2026
Date RFP Submissions due to the Department: at 2:00 p.m. EST
Proposals will be opened: at 2:00 p.m. EST
Contract Type: Open Market
Commodity Number: 811620 - Cloud-based software as a service
Description: Provider Data Management/Credentialing Verification Organization (PDM/CVO)
Using Agency: Department of Health and Human Services, Division of Health Benefits
Requisition No.: N/A
STATE OF NORTH CAROLINA
Department of Health and Human Services
OFFEROR:
STREET ADDRESS: P.O. BOX: ZIP:
CITY & STATE & ZIP: TELEPHONE NUMBER: TOLL FREE TEL. NO:
PRINCIPAL PLACE OF BUSINESS ADDRESS IF DIFFERENT FROM ABOVE
PRINT NAME & TITLE OF PERSON SIGNING ON BEHALF OF OFFEROR: FAX NUMBER:
OFFEROR'S AUTHORIZED SIGNATURE: DATE: EMAIL:

STATE OF NORTH CAROLINA
Department of Health and Human Services
Refer ALL Inquiries regarding this RFP to: Request for Proposal # 30-2026-017-DHB
Date RFP Issued/Posted: 6/12/2026
Tyler Ragor
Contract Specialist Date RFP Submissions due to the Department: at 2:00 p.m. EST
Medicaid.Procurement@dhhs.nc.gov Proposals will be opened: at 2:00 p.m. EST
Tyler.ragor@dhhs.nc.gov
Contract Type: Open Market
Commodity Number: 811620 - Cloud-based software as a service
Description: Provider Data Management/Credentialing Verification
Organization (PDM/CVO)
Using Agency: Department of Health and Human Services, Division of Health
Benefits
Requisition No.: N/A
EXECUTION
In compliance with this Request for Proposal (RFP), and subject to all the conditions herein, the undersigned Offeror offers and agrees to furnish and deliver any or all services proposed, at the cost
proposed and within the time specified herein. By executing this proposal, the Offeror confirms it has read, understands, and will comply with all specifications and requirements in the RFP and any
addenda in the event of contract award. By executing this proposal, the undersigned Offeror certifies that this proposal is submitted competitively and without collusion (N.C. Gen. Stat. 143-54), that
none of its officers, directors, or owners of an unincorporated business entity has been convicted of any violations of Chapter 78A of the General Statutes, the Securities Act of 1933, or the Securities
Exchange Act of 1934 (N.C. Gen. Stat. 143-59.2), and that it is not an ineligible Contractor as set forth in N.C. Gen. Stat. 143-59.1. False certification is a Class I felony. Furthermore, by executing
this proposal, the undersigned certifies to the best of Offeror's knowledge and belief, that it and its principals are not presently debarred, suspended, proposed for debarment, declared ineligible or
voluntarily excluded from covered transactions by any Federal or State department or agency. As required by N.C. Gen. Stat. 143-48.5, the undersigned Offeror certifies that it, and each of its
subcontractors, for any Contract awarded as a result of this RFP, complies with the requirements of Article 2 of Chapter 64 of the NC General Statutes, including the requirement for each employer with
more than 25 employees in North Carolina to verify the work authorization of its employees through the Federal E-Verify system. N.C. Gen. Stat. 133-32 and Executive Order 24 (2009) prohibit the
offer to, or acceptance by, any State Employee associated with the preparing plans, specifications, estimates for public Contract; or awarding or administering public Contracts; or inspecting or supervising
delivery of the public Contract of any gift from anyone with a Contract with the State, or from any person seeking to do business with the State. By executing this proposal, you attest, for your entire
organization and its employees or agents, that you are not aware that any such gift has been offered, accepted, or promised by any employees of your organization. Failure to execute/sign proposal
prior to submission shall render proposal invalid and it WILL BE REJECTED. Late proposals will not be accepted.
OFFEROR:
STREET ADDRESS: P.O. BOX: ZIP:
CITY & STATE & ZIP: TELEPHONE NUMBER: TOLL FREE TEL. NO:
PRINCIPAL PLACE OF BUSINESS ADDRESS IF DIFFERENT FROM ABOVE
PRINT NAME & TITLE OF PERSON SIGNING ON BEHALF OF OFFEROR: FAX NUMBER:
OFFEROR'S AUTHORIZED SIGNATURE: DATE: EMAIL:
Page 3 of 351 RFP #30-2026-017-DHB

Offer valid for at least 240 calendar days from date of proposal opening unless extended by the State in writing. After this time, any withdrawal of offer shall be made in writing, effective upon receipt by
the agency issuing this RFP.
ACCEPTANCE OF RESPONSE
If any or all parts of this proposal are accepted by the State of North Carolina, an authorized representative of the Department of Health and Human Services shall affix his/her signature hereto and this
document and all provisions of this Request for Proposal along with the Offeror's proposal, and the written results of any negotiations shall then constitute the written agreement between the parties. A
copy of this acceptance will be forwarded to the successful Offeror.
FOR STATE USE ONLY: Offer accepted and Contract awarded this ____ day of _______________, 20____, by
_____________________________________________________________________________
(Authoriz ed Representative of NC Department of Health and Human Services)
Page 4 of 351 RFP #30-2026-017-DHB

Table of Contents
1.0 General Procurement Information and Notice to Offerors ................................................................... 8
1.1 Important Notices ................................................................................................................. 8
1.2 Procurement Information ...................................................................................................... 9
1.3 Request for Proposal Functionality and Related Notices .................................................... 10
1.4 Schedule and Important Events .......................................................................................... 11
2.0 Purpose of RFP ...................................................................................................................................... 13
2.1 Introduction ......................................................................................................................... 13
2.2 Contract Term ..................................................................................................................... 14
2.3 Contract Type ..................................................................................................................... 14
2.4 Agency Background ........................................................................................................... 14
3.0 RFP Requirements and Specifications ................................................................................................ 15
3.1 Scope Of Work ................................................................................................................... 15
3.2 General Requirements and Specifications.......................................................................... 29
3.2.1 REQUIREMENTS ........................................................................................................ 29
3.2.2 Specifications ............................................................................................................... 29
3.2.3 Site and System Preparation ....................................................................................... 29
3.2.4 Equivalent Items .......................................................................................................... 29
3.2.5 Enterprise Licensing..................................................................................................... 29
3.2.6 ENTERPRISE ARCHITECTURE STANDARDS .......................................................... 30
3.3 Security Specifications ....................................................................................................... 30
3.4 Enterprise Specifications .................................................................................................... 32
3.5 Business and Technical Requirements .............................................................................. 33
3.6 Business and Technical Specifications ............................................................................. 116
3.7 Option Requirements and Specifications - RESERVED ................................................... 125
4.0 Cost of Vendor's Offer......................................................................................................................... 125
4.1 Offer Costs ........................................................................................................................................... 125
4.2 Payment Schedule ............................................................................................................................... 126
5.0 Evaluation ............................................................................................................................................. 126
5.1 Source Selection .............................................................................................................. 126
5.2 Evaluation Criteria ............................................................................................................ 127
5.3 Best and Final Offers (BAFO) ........................................................................................... 128
5.4 Possession And Review ................................................................................................... 128
Page 5 of 351 RFP #30-2026-017-DHB

5.5 Competitive Range ........................................................................................................... 129
5.6 System Demonstrations.................................................................................................... 129
6.0 Vendor Information and Instructions ................................................................................................. 129
6.1 General Conditions of Offer .............................................................................................. 129
6.1.1 Vendor Responsibility ................................................................................................ 129
6.1.2 Rights Reserved ........................................................................................................ 130
6.1.3 Solicitation amendments or revisions ......................................................................... 130
6.1.4 Oral Explanations ....................................................................................................... 131
6.1.5 E-PROCUREMENT ................................................................................................... 131
6.1.6 Electronic Vendor Portal ............................................................................................ 131
6.1.7 Protest Procedures .................................................................................................... 131
6.2 General Instructions for Vendor ........................................................................................ 132
6.3 Instructions for Offer Submission ...................................................................................... 134
7.0 Other Requirements and Special Terms ............................................................................................ 138
7.1 Vendor Utilization Of Workers Outside of U.S. ................................................................. 138
7.2 Financial Statements ........................................................................................................ 138
7.3 Financial Resources Assessment, Quality Assurance, Performance and Reliability ........ 139
7.4 Vendor's License or Support Agreements ........................................................................ 139
7.5 Resellers - Reserved ........................................................................................................ 139
7.6 Disclosure Of Litigation ..................................................................................................... 139
7.7 Criminal Conviction ........................................................................................................... 140
7.8 Security and Background Checks ..................................................................................... 140
7.9 Assurances ....................................................................................................................... 140
7.10 Confidentiality of offers .................................................................................................. 141
7.11 Project Management ..................................................................................................... 141
7.12 Meetings ....................................................................................................................... 142
7.13 Recycling and Source Reduction - Reserved ................................................................ 143
7.14 Special Terms And Conditions ...................................................................................... 143
7.15 Technical Operations .................................................................................................... 153
7.16 Help Center ................................................................................................................... 154
7.17 Testing .......................................................................................................................... 155
7.18 Incident Prioritization ..................................................................................................... 157
Attachment A: Definitions ............................................................................................................................. 158
Attachment B: Department of Information Technology Terms and Conditions ....................................... 170
Page 6 of 351 RFP #30-2026-017-DHB

Attachment J: Enterprise
Attachment K: Vendor Key Personnel

Section 1: General Terms and Conditions Applicable to All Purchases ................................................... 170
Section 2: Terms and Conditions Applicable to Information Technology Goods and Services ................ 182
Section 3: Terms and Conditions Applicable to Personnel and Personal Services .................................. 185
Section 4: Software as a Service (SaaS) Terms and Conditions (Only Applies to Proposed SaaS Solutions) 187
Attachment C: Agency Terms and Conditions ............................................................................................ 196
Section 1: NCDHHS Department of Health Benefits (DHB) ..................................................................... 196
Section 2: NCDHHS Privacy and Security Office (PSO) .......................................................................... 207
Section 3: NCDHHS Development of Artificial Intelligence Systems ........................................................ 211
Attachment D: Description of Offeror ........................................................................................................... 217
Attachment E: Cost Form .............................................................................................................................. 218
Attachment F: Vendor Certification Form .................................................................................................... 221
Attachment G: Location of Workers Utilized by Vendor ............................................................................. 222
Attachment H: Vendor References/Past Performance ................................................................................ 224
Attachment I: Financial Review Form ........................................................................................................... 231
Attachment J: Enterprise Architecture ......................................................................................................... 233
Attachment K: Vendor Key Personnel .......................................................................................................... 235
Attachment L: Service Level Agreements.....................................................................................245
Attachment M: Contract Administrators ...................................................................................................... 260
Attachment N: Deliverables And Milestones Schedule .............................................................................. 262
Attachment O: Business Continuity Plan ..................................................................................................... 301
Attachment P: Disaster Recovery Plan ........................................................................................................ 303
Attachment Q: State Certifications ............................................................................................................... 306
Attachment R: Federal Certifications ........................................................................................................... 309
Attachment S: Business Associate Agreement ........................................................................................... 317
Attachment T: Technical / Management Proposal ...................................................................................... 321
Attachment U: Conceptual Architectural Diagrams .................................................................................... 323
Attachment V: Medicaid Integration Services Core Capabilities ............................................................... 324
Attachment W: Work Products ...................................................................................................................... 330
Attachment X: Request for Proposed Modifications to The Terms and Conditions ................................ 336
Attachment Y: Minimum Qualifications ........................................................................................................ 337
Attachment Z: SUBCONTRACTOR IDENTIFICATION FORM ...................................................................... 339
Attachment AA: Reports ................................................................................................................................ 341
Attachment AB: Interfaces ............................................................................................................................ 343
Attachment AC: GenAI Disclosure and Fact Sheet ..................................................................................... 348
Page 7 of 351 RFP #30-2026-017-DHB

1.0 GENERAL PROCUREMENT INFORMATION AND NOTICE TO OFFERORS
1.1 IMPORTANT NOTICES
Offerors are Cautioned to Read Carefully
1.1.1 READ, REVIEW, AND COMPLY
It shall be the Offeror's responsibility to read this entire document, review all enclosures and attachments, and any addenda thereto, and
comply with all requirements specified herein, regardless of whether appearing in these Instructions to Offerors or elsewhere in this RFP
document.
1.1.2 EXECUTION OF PROPOSAL
Failure to sign the Execution Page in the indicated space and return all attachments, tables, charts, exhibits, diagrams, and appendices
completed and signed where required shall render the proposal non-responsive.
1.1.3 RESULTING CONTRACT
Under the State's procurement process, any contract resulting from this RFP will consist of the RFP and the Offeror's response, along with
any addenda to the RFP, written Clarifications, Best and Final Offers (BAFO), and negotiation documents. The Contractor will be obligated
to perform services as proposed in its offer, unless otherwise modified by Clarification, BAFO, negotiation, or Contract amendment, or
superseded by a document with higher order of precedence. See Attachment C: Agency Terms and Conditions, Section 1, Paragraph 14
Entire Agreement and Order of Precedence, of this document for more information and the order of precedence of the contract documents.
See section 1.3 Request for Proposal Functionality and Related Notices in this section for more information on the RFP, changes in
specifications, and instructions regarding modifications to the terms and conditions.
1.1.4 POTENTIAL NEGOTIATIONS
The Department reserves the right to enter into negotiations with one or more Offerors to establish a contract that is in the best interest of
the Department. Negotiations are specific to each Offer and shall be conducted to maximize the State's ability to obtain the most
advantageous offer based on the evaluation factors set forth in the RFP. Such negotiations are at the Department's sole discretion and may
result in modifications to the RFP and/or Offeror's proposal/response to the RFP.
1.1.5 EVENTS AND DEADLINES
a. Pre-proposal Conference will be hosted by the Department on the date and time indicated in the RFP Schedule in Section 1.4.1.
b. Questions concerning this RFP must be submitted in writing by the date and time indicated in the RFP Schedule in Section 1.4.1.
c. Submission of Proposals will be accepted until the date and time indicated in the RFP Schedule in Section 1.4.1.
Page 8 of 351 RFP #30-2026-017-DHB

1.1.6 BIDDER'S LIBRARY
The Bidder's Library is a collection of documents, data, and reference materials that the Department provides to prospective Offerors during
the Request for Proposal (RFP) process. Its primary purpose is to give Offerors access to relevant background information necessary to
develop informed, accurate, and compliant proposals. The contents of the Bidder's Library are provided solely for informational purposes
and will not be included as part of the final contract.
The documents contained in the Bidder's Library will be available only while the solicitation remains open in the Ariba Sourcing Tool. Offerors
are strongly encouraged to review the Bidder's Library section found in the solicitation in the Ariba Sourcing Tool and download the
documents for review and future reference. After the solicitation closes in the Ariba Sourcing Tool, the documents in the Bidder's Library will
no longer be accessible.
The content of the Bidder's Library reflects the current state of information at the time the RFP is issued and is not guaranteed to be updated
throughout the procurement process.
1.2 PROCUREMENT INFORMATION
1.2.1 INFORMATION AND DESCRIPTIVE LITERATURE
The Offeror shall furnish all information requested as part of this RFP. Each Offeror shall submit detailed information with their proposal (e.g.,
narratives, diagrams, exhibits, examples, sketches, descriptive literature, complete specifications) to support the services and products
offered
1.2.2 RESERVED
1.2.3 MISCELLANEOUS
Pronouns, whether masculine, feminine, or gender-non-specific, shall be read to be inclusive of all genders and shall be read to include the
plural and vice versa.
1.2.4 INFORMAL COMMENTS
The Department shall not be bound by informal explanations, instructions or information given at any time by anyone on behalf of the
Department prior to or during the competitive process or after award, including but not limited to policy papers or any written or verbal
statements whatsoever made outside of this RFP and any formal Addenda issued herewith. The Department is bound only by information
provided in this RFP and in formal Addenda issued
1.2.5 OFFEROR'S REPRESENTATIVE
Page 9 of 351 RFP #30-2026-017-DHB

Each Offeror shall submit with its proposal the name, title, email address, physical address, and telephone number of the person(s) with
authority to bind the Offeror and answer questions or provide clarification concerning the Offeror's proposal. This information must be included
in the Offeror's proposal and response
1.2.6 DISCLOSURE OF ARTIFICIAL INTELLIGENCE (AI) USE-
The Offeror shall disclose whether Artificial Intelligence (AI), including generative AI tools, was used in the preparation of any portion of its
response to this RFP. If AI tools were utilized, the Offeror affirms that it has reviewed and verified the accuracy, completeness, and
appropriateness of all AI-generated content. The Offeror shall remain solely responsible for the content of its submission, including any
errors, omissions, or misrepresentations resulting from the use of AI.
1.3 REQUEST FOR PROPOSAL FUNCTIONALITY AND RELATED NOTICES
1.3.1 RFP FUNCTIONALITY
a. This RFP serves two functions:
i. Define the specifications of the Solution sought by the Department; and
ii. Provide the requirements and terms and conditions of any contract resulting from this procurement.
b. All Terms and Conditions in this RFP shall be enforceable. The use of phrases such as "shall", "will", "must", "required", and
"requirements" are intended to create enforceable Contract conditions. In determining whether proposals should be evaluated or
rejected, the Department will take into consideration the degree to which the Offeror has proposed or failed to propose solutions that
are responsive to the Department's needs as described in this RFP.
1.3.2 NOTICES REGARDING RFP AND TERMS AND CONDITIONS
a. It is the Offeror's responsibility to read all instructions, terms and conditions, specifications, requirements, attachments and
appendices, and any other components made a part of this RFP and comply with all instructions and directives. The Offeror is
responsible for obtaining and complying with all addenda and other changes that may be issued relating to this RFP.
b. All questions and issues regarding any term, condition, instruction, or other component within this RFP must be submitted in
accordance with Section 6.2.2. Questions Regarding this RFP. If the Department determines that any changes will be made because
of the questions asked, then such decisions will be communicated in the form of an Addendum posted on the North Carolina electronic
Vendor Portal (NC eVP). The Department may also elect to leave open the possibility for later negotiation and amendment of specific
provisions of the Contract that have been raised during the question-and-answer period. Other than through this process, and except
as provided in Section 1.3.3 Proposed Modifications to Terms and Conditions, the Department rejects and will not be required to
evaluate or consider any additional or modified terms and conditions submitted with Offeror's proposal. This applies to any language
appearing in or attached to the RFP document as part of the Offeror's proposal that purports to vary any terms and conditions, or
Offeror's Instructions therein to render the proposal non-binding or subject to further negotiation.
c. The Offeror's proposal to this RFP shall constitute a firm offer. By execution and delivery of a proposal to this RFP, the Offeror
agrees that any additional or modified terms and conditions, whether submitted purposely or inadvertently, or any purported
Page 10 of 351 RFP #30-2026-017-DHB

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