Quick Introductions: Who's in the Room?

• Please tell us your name, title, organization, and primary responsibility for the MMIS initiative.
• Which of these roles best describes your function on this project? Options: Medicaid Director/Deputy Director, CIO/IT Executive, Program Operations Lead, Finance/Budget Lead, Legal/Compliance, QA/Testing Lead, Vendor/Integrator, Other
• Who else on your team should we consider core to this effort (list names, titles, and best contact method)?
• How do you prefer initial stakeholder coordination to happen—short email summaries, structured workshops, or recurring standing calls? Options: Email summaries, Structured workshop (90–120 minutes), Recurring standing calls, Shared project workspace (documents + tasks), Other
• What is one thing you want us to understand about your organization before we dig into technical details?

Who Really Holds the Keys?

• If we had to bet on who could veto this project at the last moment, who would that be and why?
• Which titles or bodies have final authority over each of these decisions: budget approval, contract award, certification go/no-go, and operational cutover? Options: Medicaid Director, Deputy Director, CIO, State Procurement, Legislative Committee, CMS State Liaison, Attorney General/Legal, Other
• Select the individuals or roles who must sign final acceptance for go-live (select all that apply). Options: Medicaid Director, CIO, Chief Financial Officer, CMS Reviewer, Provider Association Rep, MCO Representative, Other
• For each person or role with sign-off authority, what are their top three non-negotiable criteria for saying yes? (brief bullets)
• Are any decisions contingent on third parties (federal approvals, legislative action, MCO agreements)? If so, which and how?

When Does the Clock Force a Decision?

• What concrete deadline — internal, statutory, or federal — would make this project immediately critical?
• Which of these milestone categories apply to your timeline (select all that shape your schedule)? Options: RFP release / procurement milestone, Contract execution, Data conversion start, Parallel testing kickoff, CMS certification submission, Planned go-live / cutover date, Fiscal year or budget window, Other
• Which milestones are immovable versus negotiable? Options: Immovable / hard deadline, Negotiable with lead time, Flexible, Unsure
• What internal or external triggers typically force timeline changes in your agency (e.g., leadership changes, budget cycles, audits)?
• How often have timelines shifted in recent modernization projects and what was the primary cause? Options: Rarely (almost never), Occasionally (some slippage), Frequently (common), This is our first major change

If CMS Says No, What Happens?

• How would a delayed or failed CMS certification change executive appetite for moving forward?
• Who is your current point of contact at CMS (state liaison) and who are the expected federal reviewers by role or name?
• Which certification artifacts have historically required the most rework during reviews (select all that apply)? Options: Testing evidence and scripts, Accuracy reports, Interface / data flow documentation, Security & privacy documentation, Operational readiness plans, T-MSIS / federal reporting evidence, Other
• What level of independent evidence (third-party audits, sample claims passes, provider attestations) would satisfy CMS reviewers in your view? Options: Third‑party audit reports, Full production-parallel results, Provider/end-user confirmations, Detailed test cases and traceability, Combination of the above, Unsure
• Do you have prior CMS findings or corrective action items we should review now? Please summarize the top issues and outcomes.

The People Outside State Hall Who Can Make or Break This

• Which external partners, if left uncoordinated, could stop claims from paying correctly on day one?
• Please identify the MCOs, PBMs, large provider groups, and clearinghouses that must be actively engaged (name + primary contact if available).
• Which partner types in your market require customized coordination efforts (select all that apply)? Options: Managed Care Organizations (MCOs), Pharmacy Benefit Managers (PBMs), Behavioral health carve-outs, Tribal health entities, Large hospital systems, Regional community providers, Clearinghouses/EHR vendors, Other
• What have been the most frequent coordination failures with external partners in past projects (give 1–2 concrete examples)?
• How do you prefer to structure partner engagement during transition: joint working groups, bilateral testing lanes, or partner-led testing with state oversight? Options: Joint cross-organizational working groups, Bilateral integration lanes per partner, Partner-led testing with reporting to state, Ad hoc engagement as issues arise, Other
• What level of participation can we expect from MCOs/PBMs during parallel testing (passive monitoring, active test participants, co-signed readiness attestations)? Options: Passive monitoring, Active test participation, Formal readiness attestation required, Varies by partner, Unsure

What 'Good' Actually Looks Like for Each Person

• Imagine each stakeholder wrote a one‑sentence headline about success after go‑live—what would the Medicaid Director, CIO, CMS reviewer, MCO director, PBM lead, and providers each say?
• Select the measurable success signals the Medicaid Director will likely use to judge success. Options: CMS certification achieved, Claims accuracy ≥ 99.5%, Claims throughput meets SLA, No provider payment interruptions, On-budget implementation, Stakeholder satisfaction, Other
• Which technical metrics will the CIO prioritize post-go-live (select all that apply)? Options: End-to-end throughput (claims/hr), System uptime/availability, Interface error rates, Response time for eligibility checks, Modularity / MITA alignment, Data integrity checksums, Other
• From providers' perspective, which operational outcomes will make them feel the transition was successful? Options: Faster claim adjudication, Fewer denials and clearer remits, Reliable provider portal access, Clear training and support, No reimbursement delays, Other
• Which stakeholder is likely to have the strictest acceptance criteria and what are those criteria in concrete terms?
• How would you rank stakeholder risk tolerance on a five‑point scale (1 = extremely risk averse, 5 = willing to accept higher risk for faster results)? Options: 1 - Extremely risk averse, 2 - Risk averse, 3 - Moderate, 4 - Risk tolerant, 5 - Aggressive

Keeping Promises: Governance, Communication, and Escalation

• When things inevitably go sideways, who is called first and who actually has the authority to pause or stop a cutover?
• Which governance model do you prefer to use for this program? Options: Executive steering committee, Program management office (PMO) with sponsors, Technical working group + executive oversight, CMS liaison integrated into governance, Hybrid model, Other
• How frequently should executive and technical governance meetings occur during pre-deployment and cutover phases? Options: Weekly, Twice weekly, Bi-weekly, Monthly, Ad hoc as needed
• What escalation path and maximum decision windows are acceptable for critical issues (e.g., 4 hours, 24 hours, 3 business days)? Options: 4 hours, 24 hours, 48 hours, 3 business days, 7+ business days
• Which artifacts must be produced and signed at each governance checkpoint (examples: risk register, test pass/fail evidence, executive go‑no‑go memo)? List required documents.
• How will we track and share actions and decisions so nothing is lost between meetings? Options: Action tracker with owners/due dates, Shared meeting minutes repository, Weekly executive brief, Integrated project management tool (state or vendor), Other

Readiness & Red Lines: Constraints We Must Respect

• What non‑negotiable constraints would make leadership pull the plug even if technical tests are passing?
• Which regulatory, statutory, or budget constraints must we not violate (select all that apply)? Options: State statute on provider payments, Federal matching requirements, HIPAA / privacy rules, Tribal data agreements, Appropriations timing, Procurement rules, Other
• Are there financial penalties or legal consequences tied to downtime, delayed payments, or missed certification milestones? Options: Yes, No, Unsure
• If yes or unsure, please describe the nature and magnitude of those penalties or political consequences.
• What minimum level of parallel processing validation will satisfy you (select one)? Options: Full production-parallel for a defined period (specify), Percentage-based parallel sampling (specify %), Provider-segmented parallel validation, Hybrid approach (mix of the above), Unsure / want to discuss
• Are there specific data privacy, consent, or tribal sovereignty rules that shape how we handle certain member or provider records?

Next Steps and Commitment Signals

• What would you need to see or receive in the next 30 days to feel this initiative is likely to succeed?
• Which immediate decisions or signoffs can your team commit to in the next 30–60 days (select all you can commit to now)? Options: Confirm executive sponsor, Designate CMS liaison, Allocate SME FTEs, Approve initial timeline, Authorize vendor workshops, Other
• What internal resources (roles and approximate FTEs) will you allocate to the transition team?
• How would you like us to present the stakeholder alignment summary (one-page executive memo, slide deck, recorded workshop summary)? Options: One-page executive memo, Slide deck with action items, Recorded workshop + transcript, Detailed alignment workbook, Other
• Who should receive the first formal stakeholder alignment summary (list names/titles)?
• Would you be willing to schedule a 90‑minute alignment workshop in the next two weeks to finalize roles, timeline, CMS contacts, and partner coordination plans? Options: Yes, Maybe, No

Tell Us Where You Stand Today

• Who are the core decision-makers and day-to-day leads for MMIS in your organization? Please list titles and teams.
• Which incumbent MMIS vendor(s) and product versions are currently live for claims, eligibility, and pharmacy?
• What is the current CMS certification status for your MMIS (claims, encounters, pharmacy)—and when was the last certification evidence submitted? Options: Fully certified (all modules), Partially certified (some modules), Certification pending/under review, Not certified / unknown
• Roughly how many claims and transactions does the system process in a typical month, and where are your peak-volume months?
• How long has the incumbent system been in production (approx years) and when was the last major modernization or large upgrade? Options: <1 year, 1–3 years, 4–7 years, 8–12 years, 12+ years
• Who outside the agency do we need to consider immediately (MCOs, PBMs, CMS reviewers, fiscal agents)? Please name organizations and roles.

If Things Went Wrong Tomorrow, What Would Surprise You Most?

• If the incumbent MMIS suffered a major failure tomorrow, what's the single outcome you think would be most damaging to beneficiaries or payments? Options: Delayed provider payments, Incorrect eligibility decisions, Certification risk/escalation, Mass claim denials/reprocessing, Provider network outages, Other
• Which technical components or integrations would you expect to fail first and why? Options: Claims adjudication engine, Eligibility engine, Provider roster sync, Pharmacy interface (NCPDP), Third‑party payer reconciliations, Real‑time eligibility APIs, Other
• Tell us about any outages or near-miss incidents in the last 24 months—what happened, root cause, and how it was resolved.
• How are production issues typically detected—automated monitoring, provider calls, MCO escalations, CMS audit, or other channels? Options: Automated monitoring/alerts, Provider helpdesk tickets, MCO escalations, CMS inquiry/audit, Internal staff discovery, Other
• When a critical outage occurs, what's the usual time-to-recovery (TTR) and what resources are mobilized? Options: <1 hour, 1–6 hours, 6–24 hours, 1–3 days, 3+ days

How Solid Is the Data That Runs Everything?

• How confident are you that the data flowing into claims (eligibility, provider files, pharmacy, encounters) reflects a single, auditable source of truth? Options: Very confident, Somewhat confident, Unsure, Not confident
• Map the primary data flows we should know about (origin system → transformation → destination). Please include frequency and owner for each flow.
• Which interfaces run in batch vs near‑real‑time vs synchronous APIs? (select all that apply and add comments if needed) Options: Batch (nightly/ETL), Near‑real‑time (hourly/minutely), Synchronous API calls (real time), Manual file transfers (SFTP), Provider portal uploads, Other
• Which feeds or endpoints regularly generate data errors, duplicates, or reconciliation exceptions?
• Do you maintain formal data lineage, schema docs, and transformation logic for each feed? If yes, where/how are they stored? Options: Complete documentation available, Partial documentation, Ad hoc notes only, None
• Who owns data quality remediation (agency team, vendor, shared governance), and what SLAs govern fixes?

What Hidden Dependencies Could Break a Transition?

• What vendor or custom integrations are so tightly coupled to your incumbent that replacing them would likely require parallel remediation?
• Which third parties must be engaged early because their approvals or certification inputs are mission‑critical (select all that apply)? Options: CMS review team, Managed Care Organizations (MCOs), Pharmacy Benefit Managers (PBMs), Fiscal agents, Clearinghouses, State fiscal office/Treasury, Other
• Are there business rules or edits encoded in fragile ways (hard‑coded scripts, spreadsheets, or vendor‑specific modules) that would complicate migration? Options: Many hard‑coded/custom rules, Some customizations, Mostly configurable rules, Unknown / need assessment
• Which certifications, external test harnesses, or reference environments rely on incumbent‑specific behavior?
• Describe any contractual, legal, or data‑sharing constraints (e.g., PHI storage, cross‑state integrations) that would limit how we handle conversions.
• What operational processes (billing cycles, reconciliations, provider roster updates) are most vulnerable during a vendor-to-vendor handoff?

Where Certification Could Trip Us Up

• What about your current certification posture makes you uneasy—are there areas you expect CMS to scrutinize closely?
• Which certification artifacts do you already have available (edit tables, test cases, TMS logs, test harness outputs)? Options: Full artifact set, Partial artifacts, High‑level summaries only, None / not accessible
• Are there active findings, corrective action plans, or open audit items with CMS we need to be aware of? Options: Active CAPs/open findings, Under assessment but no CAP, No current findings, Unknown
• Which specific adjudication areas worry you most for passing certification (e.g., eligibility determinations, payment accuracy, encounter reporting, pharmacy pricing)? Options: Eligibility, Claims edits and accuracy, Throughput/performance, Encounter reporting, Pharmacy adjudication/pricing, Third‑party liability, Other
• How has the agency historically handled CMS inquiries—do you have a defined CMS engagement plan and single point of contact? Options: Proactive & structured engagement, Reactive as needed, Ad hoc / multiple contacts, No clear process
• What is your acceptable threshold for claims accuracy and processing latency as it relates to certification and provider impact?

If We Could Eliminate One Risk, Which Would It Be?

• Pick the single highest‑impact transition risk you want us to eliminate or mitigate above all others. Options: Data conversion errors, Provider payment delays, Certification failure, MCO disruption / network issues, PBM reconciliation failures, Integration breakages with external partners, Insufficient agency staffing/knowledge transfer
• Beyond that single risk, select the next 2–3 risks you consider material (so we understand scope and prioritization). Options: Data conversion errors, Provider payment delays, Certification failure, MCO disruption / network issues, PBM reconciliation failures, Integration breakages, Staffing / knowledge gaps, Regulatory timing constraints, Other
• Tell us about past data conversions or migrations that surprised you—what went wrong and what you'd want done differently?
• What technical or governance controls would make you feel comfortable that this risk is truly mitigated (examples: full reconciliation, parallel processing, provider holdback rules)?
• Who within your governance structure must sign off that the risk is acceptable or mitigated (titles/teams)?

How Will We Know We Succeeded 60 Days After Cutover?

• Imagine day 60 post‑cutover—what three measurable signals will convince you the transition was safe and successful?
• Which stakeholders must explicitly confirm acceptance (select all that will sign or provide formal acceptance evidence)? Options: CMS certification team, Medicaid Director, Deputy Director for Operations, CIO/IT, MCO medical directors, PBM leads, Provider association representatives, Other
• What target metrics should be met for claims accuracy, throughput, and payment timeliness (please provide numeric targets where possible)?
• Which parallel testing gates, reconciliation artifacts, or certification deliverables do you require before we move from pilot → phased cutover → full cutover? Options: Parallel test pass rate threshold, End‑to‑end reconciliation signoff, Provider pilot approvals, MCO operational readiness, Certification evidence, Other
• How do you prefer to consume cutover status and risk reporting—interactive dashboard, daily executive brief, working‑level tracker, or scheduled standups? Options: Interactive dashboard, Daily executive brief (email), Daily working‑level standup, Ad hoc incident reports, Weekly consolidated report

A Short Status Check — Where We Stand Today

• How would you describe the project’s current phase and schedule against go-live? Options: On schedule, At risk (minor delays), At risk (major delays), Paused
• What single constraint is most likely to change your planned deployment date?
• Which incumbent MMIS vendor and version are we converting from? Options: Vendor A, Vendor B, Vendor C, Custom/Legacy, Other
• What is the current CMS certification status for your incumbent environment (production and any shadow systems)? Options: Fully certified, Conditional/waiver, In remediation, Uncertified / legacy
• Roughly how many providers, beneficiaries, and average daily claims are we planning to convert and run in parallel?
• Who is our primary state sponsor(s) and day-to-day operational contact for deployment decisions? Please include role and preferred contact method.

What If Your Data Isn’t As Ready As You Believe?

• If we discovered critical mismatches in provider or member master data a week before cutover, how confident are you that we could resolve them without delaying go-live? Options: Very confident, Somewhat confident, Uncertain, Not confident
• Which data domains are you most worried about for conversion and why? Options: Provider master, Member eligibility, Claims history, Financial adjustments, Pharmacy data, Other
• Do you already have canonical data mappings or ETL rules for the incumbent -> target MMIS? If yes, where are they stored and who maintains them? Options: Yes, up to date, Yes, partial, No, planned, No, none exist
• Share an example of a recent data quality issue you faced (what happened, impact, how it was fixed).
• Who owns data remediation day-to-day in your organization and who escalates unresolved issues? Options: State IT, Business operations, External vendor, Joint governance

Hidden Interfaces: How Many Fingers Are on Your System?

• How many external integrations (MCOs, PBMs, pharmacies, HIEs, federal feeds) do you anticipate requiring active conversion and cutover coordination? Options: 1–5, 6–15, 16–50, 50+
• Which integrations carry the highest transition risk and why (give 2–3 examples tied to business impact)?
• Which integration owners have already committed to test schedules and cutover windows? Options: State agency, MCOs, PBM, Managed vendors, Not yet committed
• What batch schedules, nightly jobs, or external cutover events must we preserve or coordinate to avoid downstream outages?
• Are there any interfaces that cannot be paused or run in parallel without regulatory or payment impacts? Options: Yes, No, Unsure

Can We Spin Up Environments Fast Enough to Safely Test Cutover?

• Do you have pre-production environments that mirror production (data volume, third-party connectivity, performance profiles)? Options: Yes, full parity, Partial parity, Minimal parity, No/none
• What environment types will you require from us during deployment (select all that apply)? Options: Development, Integration/QA, Performance, Pre-Prod/Shadow, Disaster Recovery, Other
• How long does it typically take for your org (or vendors) to approve environment access requests and privileged credentials? Options: <1 business day, 1–3 business days, 4–10 business days, >10 business days
• Describe your current approach to masking or securing PII in test datasets and any constraints we should know about.
• Rate your confidence that available test environments will reveal production-scale issues before cutover. Options: High, Moderate, Low, None

Parallel Processing Isn’t Optional — How Will You Know It’s Working?

• If parallel runs show a 0.3% variance in adjudication outcomes compared to incumbent, would you accept that as within tolerance? Options: Yes, No, Need to discuss thresholds
• Which reconciliation methods do you prefer for parallel claims validation (select all that apply)? Options: Line-level diff, Summary totals, Claim sampling plus audits, Provider-level financial reconciliation, Automated exception reports
• What statistical confidence or SLA thresholds must parallel testing meet before you’ll allow cutover to proceed? Options: >99.9% accuracy, >99.5% accuracy, Business-agreed thresholds, No formal thresholds yet
• Who will staff and own daily parallel run reconciliation and exception resolution on both state and vendor sides?
• How many full parallel cycles do you expect to complete, and what are realistic durations for each cycle? Options: 1–2 cycles, 3–5 cycles, 6+ cycles, Undetermined

Who Signs Off When Things Get Real?

• If we required a hard gate that only the Medicaid Director (or delegate) can clear, would that slow approval timelines? Options: Yes, significantly, Somewhat, No
• Which stakeholders must formally sign acceptance before cutover (choose all that apply)? Options: Medicaid Director, Deputy Director Ops, CIO/IT Director, CMS liaison, Finance/Controller, Legal/Procurement, MCO leadership, PBM leadership, Provider council
• What artifacts or evidence do you need for signoff (examples: reconciliation report, performance test results, CMS documentation)? Options: Reconciliation summary, End-to-end throughput tests, Certification evidence, Training completion logs, Security review
• Describe your ideal governance meeting cadence and decision authority during the 8 weeks before cutover.
• Do you have a named CMS engagement contact and an agreed cadence for pre-cutover certification activities? Options: Yes, named and scheduled, Identified but unscheduled, Not yet engaged with CMS

If We Have to Stop the Cutover Midstream, What’s Our Exit Strategy?

• What specific triggers would force you to halt cutover and revert to incumbent processing?
• Do you currently have a documented rollback plan with timelines, data reconciliation steps, and communications templates? Options: Complete plan, Draft plan, No plan
• Who is authorized to call a stop-the-cutover decision, and how will that decision be communicated across partners?
• If rollback occurs, what are acceptable recovery SLAs for claims processing and provider payments? Options: 24 hours, 48 hours, 72 hours, >72 hours
• How will financial exposure be tracked and owned if a rollback causes payment timing disruptions?

How Will We Know We’ve Succeeded — And Keep Improving?

• What are the top 3 measurable success signals that will convince you the new MMIS is delivering promised value? Options: CMS certification, Claims accuracy/defect rate, Throughput/performance, Provider payment timeliness, Reduced manual adjustments, Interoperability metrics
• What monitoring, dashboards, or KPIs do you expect to see in the 90 days after cutover?
• What post-cutover support model do you prefer (select one)? Options: Dedicated on-site support, Remote 24/7 war room, Hybrid on-site & remote, Standard support hours
• How should lessons learned and continuous improvement items be captured, prioritized, and acted on after go-live? Options: Weekly retrospectives, Centralized backlog with governance, Ad-hoc after-action reports, Other
• Who will be accountable for tracking post-cutover SLA compliance and coordinating escalations among state, vendor, and third parties?

Starting Line: Who and What We’re Working With

• Who are the people on your core Medicaid leadership and technical team we should know (roles/titles)? Options: Medicaid Director, Deputy Director - Operations, CIO/CTO, Program Manager, Procurement Lead, CMS Liaison, Other
• Which incumbent MMIS or modules are currently in production for your Medicaid program? Options: Full legacy MMIS vendor (claims + eligibility), Claims-only engine, Modular third-party modules (eligibility, PBM, MCO), Homegrown system, Cloud-hosted MMIS, Other
• How would you describe the current system’s certification status and most recent CMS interactions? Options: Fully certified; no open conditions, Certified with minor corrective actions, Undergoing recertification, Recently decertified/under remediation, Uncertain/unknown
• What are the main programs covered (e.g., fee-for-service, managed care, pharmacy carve-out) and any special populations we should know about?
• Which integrations do you rely on today (examples: MCO EDI feeds, PBM interfaces, eligibility feeds, provider directories)? Options: MCO encounter feeds, PBM claims/eligibility, State eligibility system, Provider enrollment system, Third-party analytics, HIE/ADRs, Other
• Tell us about your typical claims volume and peak throughput requirements (daily/hourly) and whether you expect those to change in the next 12–36 months.

If CMS Showed Up Tomorrow, Would We Pass?

• On a scale from 1–5, how confident are you that your current claims environment meets CMS certification evidence and audit readiness today? Options: 1 - Not confident, 2 - Low confidence, 3 - Somewhat confident, 4 - Confident, 5 - Very confident
• What specific areas of certification do you think are most vulnerable (e.g., accuracy, reporting, test artifacts, data lineage)? Options: Claims accuracy, Throughput/performance, Federal reporting completeness, Test artifact quality, Data conversion validation, Interoperability requirements, Other
• How long have you been operating with the current level of certification risk, and what events triggered that reality?
• Who in your organization would be accountable for responding to a CMS conditional finding, and how quickly can that person mobilize resources? Options: Medicaid Director, Deputy Director - Ops, CIO/CTO, Compliance Lead, Program Manager, Unknown
• What evidence (artifacts, test packs, performance logs) do you currently have ready to demonstrate compliance, and where are the gaps?
• If we discovered a significant defect during parallel testing, how much operational pain (payments delayed, provider upset) would you expect, and who would feel it first? Options: Major statewide impact, Localized provider network disruption, Temporary minor delays, Minimal impact

Who Really Calls the Shots (and Who Gets Blamed)?

• When a high-stakes decision about the MMIS is required, who has the final sign-off and what criteria do they use? Options: Medicaid Director, Governor’s Office, CIO/CTO, Procurement/Legal, Steering Committee, Other
• Which external stakeholders must be engaged for decisions (CMS contacts, MCO leadership, PBMs, providers), and how involved are they today? Options: CMS regional office, MCO medical directors, PBM operations, Provider associations, Tribes/behavioral health partners, Other
• What political, budgetary or statutory constraints shape your timeline and choices (examples: fiscal year budgets, legislative approvals)?
• Have past transitions involved unexpected governance failures? If so, what happened and what was the downstream impact?
• How do your providers and MCOs typically express concerns—formal change requests, escalations, or public complaints—and how quickly do those channels trigger action? Options: Formal change requests, Operational escalations, Public/provider complaints, Regulatory escalations, Rarely heard from
• Which stakeholder’s definition of ‘good’ do you worry will be hardest to align on during a transition, and why? Options: CMS, MCOs, PBMs, Providers, State leadership, IT/Ops team

When Systems Go Quietly Wrong — Stories That Matter

• Can you describe a recent incident where claims accuracy or throughput materially impacted beneficiaries or providers—what happened, and how did it feel for your team?
• How often do you detect silent failures (e.g., incorrect remits, underpayments discovered later) versus loud outages, and what tools pick them up? Options: Daily, Weekly, Monthly, Rarely, Unknown
• Which failure modes worry you most during a transition: data conversion errors, interface mismatches, batch timing shifts, or human-process gaps? Options: Data conversion errors, Interface mismatches, Batch timing/scheduling, Training/process gaps, Testing coverage gaps, Other
• When problems surface, what’s your typical remediation path (hotfix, rollback, manual adjustments), and how long do fixes usually take?
• Who in your vendor ecosystem becomes the single point of escalation during incidents, and how effective has that been historically? Options: Current MMIS vendor, State IT team, Third-party integrator, PBM/MCO vendor, No clear owner
• How does prolonged instability affect provider behavior (paper claims, provider churn, late credentialing) and what stories have you heard from networks?

What Are You Willing to Risk to Keep Things the Same?

• If maintaining the incumbent system feels safer, what would it cost you in terms of CMS risk, missed MITA modularity, and future value-based readiness?
• Which benefits of a modern MMIS matter most to you: faster payments, higher accuracy, modular upgrades, or improved reporting to CMS? Options: Faster payments, Higher accuracy, Modularity/roadmap, Reporting and compliance, Interoperability, Provider experience
• How would your stakeholders react if a transition delayed payments or reporting for a quarter—political fallout, provider pushback, or federal scrutiny? Options: Severe political fallout, Provider outrage/financial distress, Federal warning/conditions, Manageable short-term pain
• What trade-offs are you willing to accept in scope, timeline or cost to reduce transition risk? Options: Longer timeline, Higher cost, Phased module approach, Stricter parallel testing, Reduced initial functionality
• Describe one non-negotiable constraint you have (e.g., legislative deadline, CMS milestone, fiscal year cut-off).
• How have previous risk-avoidance choices impacted your ability to meet future interoperability or policy requirements?

Picture a Zero‑Surprise Transition

• Imagine a successful cutover with no provider disruption—what are the three outcomes you would point to as proof it worked?
• Which measurable success signals are highest priority for you (claims accuracy rate, end‑to‑end throughput, timely federal reporting, provider payment latency)? Options: Claims accuracy %, End-to-end throughput, Timely federal reporting, Provider payment latency, Conversion error rate, User adoption/training metrics
• What time window for stabilization post‑cutover would make leadership comfortable (e.g., 30/60/90/180 days)? Options: 30 days, 60 days, 90 days, 180 days, Other
• Which acceptance criteria would you require before declaring the transition complete (ties to CMS requirements, signed provider attestations, throughput benchmarks)?
• If we documented these success signals together, who would need to sign off and what evidence would satisfy each person? Options: Medicaid Director, Deputy Director, CIO/CTO, CMS regional office, MCO reps, Provider reps
• What would early warning signs look like that we should stop, pause, and remediate before cutover? Options: Conversion error spikes, Throughput under target, Unresolved interface exceptions, Training completion < threshold, Provider complaint surge

The Minimum Viable Plan to Sleep at Night

• What are the absolutely critical elements (data conversion, parallel testing, acceptance criteria, training) you refuse to compromise on? Options: Data conversion validation, Parallel end-to-end testing, Provider/staff training, Cutover rollback plan, Escalation governance, CMS engagement plan
• Who needs dedicated seats at a daily Operations War Room during cutover, and who should be on call 24/7? Options: Medicaid Ops lead, CIO/CTO, Vendor PM, Vendor Ops/Engineering, MCO liaison, PBM contact
• Which testing phases must be completed before we allow live claims to flow, and what pass/fail thresholds feel reasonable? Options: Unit/component, Interface/regression, Parallel processing, End-to-end certification, Provider acceptance testing
• How do you prefer to handle provider training and communication—state-run, vendor-led, hybrid, or through MCOs? Options: State-run, Vendor-led, Hybrid, Via MCOs, Other
• If we built a phased scope to reduce risk, which modules must go first and which can follow in later waves? Options: Claims adjudication, Provider enrollment, Eligibility, PBM, Managed care encounters, Reporting
• What escalation path and decision authority would you want documented for ‘day of’ issues that threaten provider payments?

Commitments, Red Flags, and Next Moves

• What commercial or contractual terms are non‑negotiable to you (liabilities, uptime SLAs, data ownership, certification support)? Options: Uptime SLA, Liability limits, Data ownership/portability, Certification support guarantee, Acceptance/penalty clauses
• Which red flags during due diligence would cause you to pause or walk away (e.g., lack of CMS artifacts, poor conversion history, staffing instability)? Options: No CMS evidence, Past failed cutovers, High employee turnover, Unclear data lineage, Insufficient parallel testing history
• What does a realistic timeline look like for you from contract signature to cutover, and what must happen in the first 60 days? Options: <6 months, 6–12 months, 12–18 months, 18+ months
• Who are the decision checkpoints you want to include (go/no-go gates), and what output should each gate produce? Options: Project initiation charter, Completion of parallel testing, Provider readiness signoff, CMS evidence package, Final commercial close
• What would be the single most comforting signal from a vendor in the first 30 days that tells you they truly understand and can shoulder transition risk?
• Would you like us to provide a tailored gap analysis and a sample readiness checklist for your team in the next two weeks? Options: Yes, please, Maybe—need more info, No, not at this time