Benefit Management System & Services (BMS) Request for Proposal (RFP) #0192-D Release!
Courtesy Notification (Issued 1/10/2019):
The State of Wyoming, Department of Health (WDH), Division of Healthcare Financing (DHCF), WINGS Project, has released the Benefit Management System and Services (BMS) For Claims Processing, Financial Management, and Third Party Liability Services Request for Proposal (RFP) #0192-D.
The BMS RFP has been posted to the Administration & Information A&I Public Purchase Online Bidding System for registered vendors to access. If you have not done so already, please register for Public Purchase HERE.
We look forward to your proposals – thank-you!
The Wyoming Integrated Next Generation System (WINGS) will replace the current Medicaid Management Information System (MMIS) through separate procurements, represented as grey boxes in the “WINGS Project—To-Be Vision” graphic (above).
The Pharmacy Benefit Management System has already been procured, and Change Healthcare holds the current contract. PBMS processes pharmacy point-of-sale claims and handles pharmacy related prior authorizations, among other duties.
The System Integrator with Enterprise Service Bus (SI-ESB) connects all of the modules together into an enterprise system so that the WINGS vision can be realized. This module has been procured and Deloitte holds the current contract.
The Data Warehouse with Business Intelligence Tools (DW/BI-R) serves as the main data storage repository for all the other WINGS Project modules (with the intention of bringing in data from other Department of Health areas over time). Business Intelligence Tools will be utilized to access this stored data to compile reports and analyze Medicaid program information to help inform Agency decision making. This module has been procured and Deloitte holds the current contract.
The Fraud, Waste, Abuse Analytics and Case Tracking (FWA) module will support the identification, investigation, and collection of fraud, waste, and abuse of Medicaid services by providers and clients. This module has been procured and Deloitte holds the current contract.
The Care/Case Management System (CCMS) vendor handles functions relating to Home and Community Based Services (HCBS) waivers. This Care/Case Management system will develop and monitor plans of care, capture and monitor assessments, screenings, treatment plans, and authorize services (send prior authorizations to the Benefit Management System).
The Provider Enrollment, Screening, and Monitoring (PRESM) module will be a stand-alone solution comprised of screening and background checks, online provider enrollment; a provider support enrollment call center and help desk, including Interactive Voice Response (IVR) software, and ongoing provider credentials monitoring.
The Benefit Management Services (BMS) module includes claims processing, adjustments, and coordination between modules and systems in order to facilitate accurate claims processing and benefit plan management according to Wyoming Medicaid business rules. Financial processes such as adjustments, withholding funds, accounts receivable, and accounts payable will also live in this module. Recently, the functions related to Third Pary Liability (TPL) have been folded into the BMS module procurement. TPL ensures that proper coordination exists between Medicaid and any other entity or individual with the obligation to provide financial support for Medicaid services rendered to a client.
There are consulting services that will act as support for the WINGS project vision as it comes to fruition. The contracts for these procurements will be used during implementation of the WINGS project during the transition from the Legacy Medicaid Management Information System to the WINGS To-Be Project Vision.
The Testing and Quality Assurance/Quality Control Services (Testing-QA/QC) vendor will define, implement, and verify a high standard of quality, accuracy, and accountability, and completeness is met for the testing activities during applicable phases of WINGS project components, in support of the Agency, to help ensure Agency requirements and business needs are addressed and met for WINGS project components. This contract has been awarded to Qualis Health.
The Independent Verification & Validation (IV&V) vendor will monitor and oversee work of the WINGS component contractors and the Agency to verify and validate that the WINGS Project systems meet all requirements and specifications to fulfill its intended purpose and readiness for CMS Certification. The IV&V Contractor will provide certification related reports to Centers for Medicare & Medicaid Services (CMS), in accordance with CMS enhanced federal funding guidelines and protocols for WINGS project activities. This contract has been awarded to SLI Government Solutions.
The Business Process Re-engineering & Optimization (BPRO) vendor will assist in streamlining processes to achieve cost reductions, enhance quality of Medicaid services provided, and find ways to shorten processes for faster turnaround.
The WINGS project modules will be procured over the next two to three years. More information on all of these procurements will follow.
Hello WINGS Project Vendors and Potential Vendors,
We want to keep you informed! If you are interested in receiving vendor fair notifications and periodic WINGS newsletters, please let us know you’d like to be put on our vendor list by signing up here:
If you are already on the WINGS Vendor List, but have not registered for Public Purchase (application used to view Agency open RFPs and submit a RFP vendor proposal). Sign up here:
We anxiously await your proposals once a RFP has been released. Please follow the instructions provided within the RFP and Public Purchase when submitting your proposal(s). As a friendly reminder, if you do not follow the instructions for submitting your proposal(s), or if you send your proposal directly to any Wyoming Department of Health staff, including the Wyoming Department of Health Director, your proposal will not be considered.
We look forward to your submissions.
The WINGS Team
Dear Wyoming Citizen,
The WINGS project is focused on you, potential and existing Medicaid clients. Our WINGS project team will not rest until our goal of streamlining and enhancing the current Medicaid service delivery system is replaced with a more integral approach to processing claims; discovering instances of fraud, waste, and abuse of Medicaid services; assisting Medicaid clients with third party liability; and other components. Over the life of the WINGS project, we will fold in other Department of Health areas in order to move away from a “siloed” healthcare approach and integrate into a comprehensive view of understanding the health of not only Medicaid clients, but all Wyoming’s citizens.
We know that spending taxpayer money (it’s our money too) is delicate, especially in these tough economic times. We are extremely conscientious of this fact, and consider it an honor to wisely use a bit of Wyoming’s general fund money. Please know that we have taken full advantage of enhanced federal funding. As you may have read in the Advanced Planning Document (APD) within the Document Library on this webpage, this enhanced federal funding will fluctuate during different project phases. You’ll see that WINGS will receive (federal funds/general funds percentages) 90/10, 75/25, and 50/50 funding. We are ensuring Wyoming’s money stretches as far as it can.
What does this mean for you? As the WINGS project gains momentum, we hope you don’t notice much. What we mean is, yes, this project will touch thousands of people, but we don’t anticipate interruptions to “business as usual.” Our vision is a seamless one, with gradual ascension.
We are in service to you.
Your WINGS Team
Status Update for Project Activities This status update report provides general information about anticipated WINGS project activities and time lines for various procurements. The status report will be posted periodically with updated information and time frames for key focus areas that may be of interest to Medicaid vendors.
WINGS Project Glossary of Terms and Abbreviations This document is for information only and contains acronyms, terms, and definitions that are commonly used in Wyoming Medicaid and WINGS Project procurements.
Procurement Strategy Executive Report This report contains Wyoming MITA 3.0 State Self-Assessment information and outcomes as well as Medicaid Management Information System (MMIS) alternative strategies based on research and vendor feedback from the Medicaid Claims Processing and Related Medicaid Administrative Services questionnaire responses received in January 2015. Wyoming Medicaid WINGS project procurement strategy for the next three years, is also included in this summary report.
Data Warehouse Takeaways This document contains descriptions of items covered and functionality demonstrated during the October 2014 Data Warehouse/Business Intelligence vendor fair.
Pharmacy Vendor Fair Takeaways This document contains descriptions of items covered and functionality demonstrated during the October 2014 pharmacy vendor fair.
Fraud, Waste and Abuse Takeaways This document contains descriptions of items covered and functionality demonstrated during the June and August 2015 Fraud, Waste, Abuse vendor fair.
Advanced Planning Document This document contains the first Implementation Advance Planning Document (IAPD) request to Centers for Medicare and Medicaid Services (CMS) for funding approval for WINGS project activities. CMS approved IAPD v1.1 on February 18, 2015 for Pharmacy Benefits Management System and Services (PBMS) and Quality Assurance/Quality Control Services (QA/QC) procurements. This IAPD will be updated to include the remaining WINGS project scope, schedule, and budget activities request for CMS funding approval.
For those who are interested in Wyoming Department of Health procurement activities and timelines, please note they are subject to change–please see Public Purchase for official Request for Proposal (RFP) notices and releases, and stay tuned for future updates!
The documents contained herein are visionary in nature, and can be changed at the sole discretion of the State. This page was last updated on January 15, 2019.