New Hampshire Department of Health and Human Services

Buyer seeks a vendor to conduct data matching to verify private insurance coverage for New Hampshire Medicaid members. The vendor will identify potential third-party payors to avoid unnecessary Medicaid payments. Buyer requires the vendor to maintain agreements with major insurance carriers and exchange data weekly. Vendor must submit insurance information to the Medicaid Management Information System twice monthly and provide real-time verification capabilities.

• 6/10/2025 - Solicitation Released
• 6/20/2025 - Letter of Intent Submission Deadline
• 6/24/2025 - Questions Submission Deadline
• 7/8/2025 - Department Response to Questions Published
• 7/18/2025 - Proposal Due Date

• Agreements with all major commercial and HMO insurers
• Agreements with specific carriers including Anthem, Cigna, Harvard Pilgrim Healthcare
• Ability to exchange data with insurance carriers weekly
• System for real-time verification of other insurance
• Experience with TPL identification and insurance data matching

• Match private insurance eligibility records against Medicaid member records
• Exchange data with insurance carriers on weekly basis
• Submit insurance data to NH Medicaid MMIS twice monthly
• Provide real-time verification of other insurance within 24 hours
• Map insurance data to NH Medicaid MMIS coverage type codes
• Submit monthly error reports and non-matching reports
• Maintain agreements with major commercial insurance carriers
• Identify private insurance at earliest opportunity to avoid unnecessary payment
• Submit active, terminated, and changed insurance information for Medicaid members
• Develop policies and procedures for TPL identification