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CMS-Certified Care Management Module

eQHealth Solutions has achieved CMS certification for our Care Management Module, making us the only vendor currently pre-certified by CMS for the Care Management sub-system.

First-Ever CMS Certification for Population Health Management Technology

eQHealth Solutions has now received the Certification for population health management technology issued by the Centers for Medicare and Medicaid Services (CMS) for the care management business area of the State of Vermont’s Medicaid program. 

While the demand for Medicaid has continued to grow, budgets have diminished, causing population health management to become an increasingly important factor. This module was developed in response to the CMS final rule in 2015 changing the governing of funding for Medicaid Enterprise Systems or Medicaid Management Information Systems (MMIS). In a shift from volume to value, the new rules for compliance allowed eQHealth Solutions to develop and bring an innovative solution to the Medicaid and Commercial markets.

Meeting the Criteria Established for Architecture and Functionality

The eQHealth Solutions State of Vermont project included multiple reviews to ensure that the system in development was on-track and compliant with all criteria.  eQHealth Solutions was required to produce written task deliverables throughout the project that detailed the system architecture, development processes and methodology, security, training, and maintenance and operations.

To achieve CMS certification, our team documented and demonstrated functional requirements of the Medicaid Enterprise Certification Toolkit (MECT), which is a component of the Medicaid Enterprise Certification Lifecycle. These functional requirements included:

  • Service Oriented Architecture (SOA)
    • Extensibility, Interfacing, Integration with Other State Modular Applications, HIE, HL7
  • Real-Time Integration Capability
  • Data Dictionaries
  • HIPAA x12 Transactions Capabilities
  • NPPES Integration
  • Industry Standard Business Rules Engine
  • Role-Based Security
  • State, Federal, HIPAA Compliance
  • HiTrust Certificate Security requirements
  • Industry Standard Code and Data Sets
  • System Performance Monitoring
  • Workflow & Event Driven Business Processing
  • Strong Data Analytics
  • Canned and Ad-hoc Reporting
    • Multiple Output Formats

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Backbone of eQHealth

  • Systems/Technology - Our deliverables created during the State of Vermont project serve as a record of our architecture, security, software development methodology and maintenance and operations. This allows us to now offer state Medicaid administrators a solution that is already pre-approved, backed by an organization that knows what it takes to achieve it.
  • Innovation - This certification is the product of eQHealth's forward-looking strategy to prepare for the future of software development in the public sector
  • Experienced Staff - The three-year design, development and implementation (DDI) period for the State of Vermont project allowed our team to understand the state's care management processes, and adjust the existing Care Management system to comply with all aspects of the MITA checklists specific to Care Management.
  • Multi-State Organization - eQHealth serves a variety of entities including federal, state and commercial clients. Our investment in innovation empowers us to customize service and ensure compliance based on the unique processes of those entities.

1st and Only CMS Certified Care Management Technology

Powering a New Generation of Population Health Management and Clinical and Financial Outcomes

Your Outcomes

  • Superior Performance - eQHealth Solution's investment of human and financial resources allows us to meet and exceed functional requirements of the Medicaid Enterprise Certification Toolkit (MECT), proven with System Performance Monitoring. 
  • Industry Leading Products -  eQHealth Solutions is in the lead position on the “Pre-Certified” list of vendors that will be highly sought after by other states that follow Vermont’s lead.
  • Quality - Our Industry Standard Code and Data Sets allow a state to stretch it's budgeted dollars further while improving quality of care and population health.
  • Value - As a Medicaid administrator, you are empowered to meet CMS requirements faster, for less.


Have any questions? Call us toll-free.1-800-720-2578