2-A01C Gen Quest 0725.pdf

PDF 453 KB Posted

Attached to
Electronic Payment Services for Patient Billing
Solicitation number
RFP 745-26-P07
Issued by
Bexar County, Texas

About this file

Summary

This document is a Proposer's General Questionnaire template issued by the University of Texas Health Science Center at San Antonio (UTHSA) Department of Purchasing for the Electronic Payment Services for Patient Billing solicitation (RFP 745-26-P07). The questionnaire requires proposers to provide comprehensive information about their company profile, approach to work, general requirements, service support capabilities, and quality assurance programs. Proposers must demonstrate their ability to provide secure, reliable, and scalable electronic payment solutions that support multiple payment channels including web, mobile, automated voice response (IVR), and in-person transactions. The solution must integrate with Epic MyChart, support automated payment posting, and enable daily reconciliation. The questionnaire requests key details including the proposer's legal name, principal place of business, years in operation, number of employees, annual revenue volume, and state of incorporation.

Proposers must provide financial statements for the past two years if requested, disclose details of any pending litigation or claims, submit a customer reference list of at least three organizations with similar contract experience within the past five years, and identify all individuals with at least 25% ownership interest for child support delinquency verification purposes. The proposal must include summary resumes of key personnel, a detailed work plan with identified tasks, timeframes, milestones, and implementation strategy, service support philosophy, quality assurance program details, and any contingency or disaster recovery plans. UTHSA does not guarantee any specific volume of services or minimum compensation under this RFP. Proposers must also declare their approach to cloud computing services and disclose any relationships between the proposer and UTHSA employees.

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DEPARTMENT OF PURCHASING | HUB PROGRAMS | Mail Code 7962 | 7703 Floyd Curl Drive | San Antonio, Texas 78229-3900

210.562.6200 | www.uthscsa.edu | https://wp.uthscsa.edu/purchasing/

Template 0725

SECTION 3

PROPOSER’S GENERAL QUESTIONNAIRE

NOTICE: WITH FEW EXCEPTIONS, INDIVIDUALS ARE ENTITLED ON REQUEST TO BE INFORMED ABOUT THE INFORMATION THAT GOVERNMENTAL BODIES OF THE STATE OF TEXAS COLLECT ABOUT SUCH INDIVIDUALS. UNDER §§552.021 AND 552.023, GOVERNMENT CODE, INDIVIDUALS ARE ENTITLED TO RECEIVE AND REVIEW SUCH INFORMATION. UNDER §559.004, GOVERNMENT CODE, INDIVIDUALS ARE ENTITLED TO HAVE GOVERNMENTAL BODIES OF THE STATE OF TEXAS CORRECT INFORMATION ABOUT SUCH INDIVIDUALS THAT IS INCORRECT.

Proposals must include responses to the questions contained in this Proposer’s General Questionnaire.

Proposer should reference the item number and repeat the question in its response. In cases where a question does not apply or if unable to respond, Proposer should refer to the item number, repeat the question, and indicate N/A (Not Applicable) or N/R (No Response), as appropriate. Proposer will explain the reason when responding N/A or N/R.

3.1 Proposer Profile

3.1.1 Legal name of Proposer company: ____________________________________

Address of principal place of business:

Street Address City State Zip

Address of office that would be providing service under the Agreement:

Street Address City State Zip

Point of Contact for this Project: ________________________________________

Email Address of Point of Contact: ______________________________________

Number of years in Business: ______

State of incorporation: _______

Number of Employees: ________

Annual Revenues Volume: ______

Name of Parent Corporation, if any ______________________________

NOTE: If Proposer is a subsidiary, University prefers to enter into a contract or agreement with the Parent Corporation or to receive assurances of performance from the Parent Corporation.

file://cfs/links/FS/Purchasing/Z_SHARED%20Management/BIDS/FY2022/1%20RFP%20745-22-PXX%20Master%20File%20February%202022/1_Working%20Documents/1_Draft%20Documents/www.uthscsa.edu https://wp.uthscsa.edu/purchasing/

3.1.2 State whether Proposer will provide a copy of its financial statements for the past two (2) years, if requested by University (if requested by University).

3.1.3 Proposer will provide a financial rating of the Proposer entity and any related documentation (such as a Dunn and Bradstreet analysis) that indicates the financial stability of Proposer (if requested by University).

3.1.4 Is Proposer currently for sale or involved in any transaction to expand or to become acquired by another business entity? If yes, Proposer will explain the expected impact, both in organizational and directional terms.

3.1.5 Proposer will provide any details of all past or pending litigation or claims filed against Proposer that would affect its performance under the Agreement with University (if any).

3.1.6 Is Proposer currently in default on any loan agreement or financing agreement with any bank, financial institution, or other entity? If yes, Proposer will specify the pertinent date(s), details, circumstances, and describe the current prospects for resolution.

3.1.7 Proposer will provide a customer reference list of no less than three (3) organizations with which Proposer currently has contracts and/or to which Proposer has previously provided services (within the past five (5) years) of a type and scope similar to those required by University’s RFP. Proposer will include in its customer reference list the customer’s company name, contact person, telephone number, project description, length of business relationship, and background of services provided by Proposer.

Reference One

Company’s Name

Contact Person Name & Email

Reference Project ID

Length of Business Relationship

Background of Services Provided by Proposer

Reference TWO

Reference Three

3.1.8 Does any relationship exist (whether by family kinship, business association, capital funding agreement, or any other such relationship) between Proposer and any employee of University? If yes, Proposer will explain.

3.1.9 Proposer will provide the name and Social Security Number for each person having at least 25% ownership interest in Proposer. This disclosure is mandatory pursuant to §231.006, Family Code, and will be used for the purpose of determining whether an owner of Proposer with an ownership interest of at least 25% is more than 30 days delinquent in paying child support. Further disclosure of this information is governed by the Texas Public Information Act (ref. Chapter 552, Government Code), and other applicable law (if requested by UTHSA).

3.2 Approach to Work

THIS SECTION SHALL BE CLEARLY PRESENTED IN YOUR SUBMITTED PROPOSAL

DO NOT ANSWER IN THIS DOCUMENT

3.2.1 Proposer will provide a statement of the Proposer’s service approach and will describe any unique benefits to University from doing business with Proposer. Proposer will briefly describe its approach for each of the required services identified in Section 5.4 Scope of Work of this RFP.

3.2.2 Proposer will provide an estimate of the earliest starting date for services following execution of the Agreement.

3.2.3 Proposer will submit a work plan with key dates and milestones. The work plan should include:

3.2.3.1 Identification of tasks to be performed;

3.2.3.2 Time frames to perform the identified tasks;

3.2.3.3 Project management methodology;

3.2.3.4 Implementation strategy; and

3.2.3.5 The expected time frame in which the services would be implemented.

3.2.4 Proposer will describe the types of reports or other written documents Proposer will provide (if any) and the frequency of reporting, if more frequent than required in this RFP.

Proposer will include samples of reports and documents if appropriate.

3.2.5 Proposer must select, and if necessary complete, one of the following two options regarding cloud computing services (“CCSs”):

_____ OPTION 1: Proposer represents and warrants that it will not provide any CCSs either through this Agreement or in furtherance of this Agreement, as provided in Section 2.16 of Appendix One.

_____ OPTION 2: Proposer represents and warrants that it will provide the following

CCSs either through this Agreement or in furtherance of this Agreement, as provided in Section 2.16 of Appendix One:

______ OPTION 3: Not applicable

3.3 General Requirements

THIS SECTION SHALL BE CLEARLY PRESENTED IN YOUR SUBMITTED PROPOSAL

DO NOT ANSWER IN THIS DOCUMENT

3.3.1 Proposer will provide summary resumes for its proposed key personnel who will be providing services under the Agreement with University, including their specific experiences with similar service projects, and number of years of employment with Proposer.

3.3.2 Proposer will describe any difficulties it anticipates in performing its duties under the

Agreement with University and how Proposer plans to manage these difficulties.

Proposer will describe the assistance it will require from University.

3.4 Service Support

Proposer will describe its service support philosophy, how it is implemented, and how Proposer measures its success in maintaining this philosophy.

3.5 Quality Assurance

Proposer will describe its quality assurance program, its quality requirements, and how they are measured.

3.6 Miscellaneous

3.6.1 Proposer will provide a list of any additional services or benefits not otherwise identified in this RFP that Proposer would propose to provide to University. Additional services or benefits must be directly related to the goods and services solicited under this RFP.

3.6.2 Proposer will provide details describing any unique or special services or benefits offered or advantages to be gained by University from doing business with Proposer. Additional services or benefits must be directly related to the goods and services solicited under this

RFP.

3.6.3 Does Proposer have a contingency plan or disaster recovery plan in the event of a disaster? If so, then Proposer will provide a copy of the plan.

Legal name of Proposer company:
Street Address:
City:
State:
Zip:
Street Address_2:
City_2:
State_2:
Zip_2:
Point of Contact for this Project:
Email Address of Point of Contact:
Number of years in Business:
State of incorporation:
Number of Employees:
Annual Revenues Volume:
Name of Parent Corporation if any:
Companys Name:
Contact Person Name Email:
Reference Project ID:
Length of Business Relationship:
Background of Services Provided by Proposer:
Companys Name_2:
Contact Person Name Email_2:
Reference Project ID_2:
Length of Business Relationship_2:
Background of Services Provided by Proposer_2:
Companys Name_3:
Contact Person Name Email_3:
Reference Project ID_3:
Length of Business Relationship_3:
Background of Services Provided by Proposer_3:
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Text16: Electronic Payment Services for Patient Billing
Text17: 745-26-P07

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