NESCSO proactively invests in State employees to improve the effectiveness of Health and Human Service agencies.

NESCSO helps State agencies improve the effectiveness of publicly funded health and human services by investing in State employees

We are excited to announce a New England-focused Medicaid Enterprise Systems Community event next Spring (April 7-9, 2025) in Providence, RI. The event will bring together the Medicaid Enterprise Systems Community for the Northeast Regional Demonstrations meeting, aka the “NERDS”, and will be similar in form to one held in 2019. Our goal is to connect you, the leading private sector organizations, with State Medicaid Agency (SMA) staff from throughout the region to highlight the innovative solutions that your organization provides.

At the event you will be able to provide in-depth insights about your product(s) or service(s) through seventy-five (75) minute demonstrations and exchange meaningful dialogue about how your organization can address the challenges the SMAs face. 

We have received a large number of applications and have closed the portal.

If you have submitted a complete application your submission will be reviewed by our teams of reviewers. We will follow up with you as soon as possible.

If you have not submitted a complete application we are not able to accept any late submissions.

State participants who are interested in attending the event can let us know by adding your contact information to our waitlist at: Sign up Here

Areas of Focus

The regional teams have identified the following areas where they want to learn more from you, and your organization, on how to improve services for their states. The primary areas of focus are:

  • Claims and Encounter Processing: Claim and encounter processing including edits, pricing and verification of prior authorizations.
  • Provider Management: Provider processing including enrollment, data maintenance and credentialing processes. Also includes online provider directories and provider portal / mobile applications.
  •  Pharmacy: Pharmacy point-of-sale processing including drug utilization review, preferred drug lists, and drug prior authorizations. Also includes drug rebate processing.
  • Advancing Program Integrity: Systems to detect and prevent fraud, waste, and abuse to promote program integrity. Include current or future plans for incorporating artificial intelligence.
  • Financial Management/Fiscal Agent: Systems which produce accurate budgeting, cost control, and interface with claims systems for timely payments to providers and other stakeholders.
  • EDI/API/FHIR Processing: Systems and interfaces which enable seamless data exchange between Medicaid systems, other healthcare systems, and Medicaid clients and authorized third parties. Include how this helps compliance with federal regulations.
  • Integrated Eligibility & Enrollment System (including Medicaid Client Portal & Mobile App): Eligibility and Enrollment processing for Medicaid, CHIP and other benefit programs. Includes Medicaid client portals/mobile applications for member access to and update (where authorized) of their data.
  • LTSS & HCBS: Adjudication of LTSS/HCBS claims to produce payable amounts for claim payment systems. Includes EVV process to match verification of delivered services to claims.
  • Transformed-MSIS Processing: T-MSIS provides critical data to CMS for program management, policy analysis, and reporting. Include information about the level of data quality from any existing clients.
  • Data Analytics/Business Intelligence/Decision Support: Data analytics including artificial intelligence to help identify trends, measure performance, and optimize program operations. Include information about data storage solutions such as commercial / government cloud providers which are offered.
  • Unified Call Center Systems/Services: Systems and services which provide a single point of contact for members, providers, and other stakeholders, to improve customer service and reduce call handling time.
  • System Integration Platforms/Services: Integration platforms/services that facilitate seamless data exchange between different systems. Include information about the systems and specific services offered.
  • Organizational Change Management Services: Medicaid organizations are constantly undergoing change to address federal and state legislative requirements as well as implement new technologies. Specify the services offered to help guide state Medicaid programs in making these organizational changes.