3-Data Sharing Assessment.docx
DOCX document 29 KB Posted
- Attached to
- iRFP Every Door Direct Mail (EDDM) Services
- Solicitation number
- 25-06880
- Issued by
- San Bernardino County, California
About this file
This is a Data Sharing Assessment Form for the Inland Empire Health Plan (IEHP) designed to evaluate third-party vendors and contractors who will handle sensitive information. The form requires vendors to provide detailed contact information, service descriptions, and data handling procedures. It establishes a framework for IEHP to assess how contractors will transmit, receive, create, and maintain sensitive information, including whether offshore resources or subcontractors will be utilized. The form captures comprehensive details about the scope of services provided and identifies specific categories of information that vendors may access, viewed, used, disclosed, or handled.
The assessment form identifies two primary data categories that vendors may handle: Personally Identifiable Information (PII) including names, addresses, dates of birth, Social Security numbers, member health plan IDs, driver's license numbers, and biometric identifiers; and Medical or Behavioral Health Information including diagnoses, admission/discharge dates, medical records, prescriptions, healthcare payment information, and claims. The form requires vendors to specify whose information will be accessed—IEHP employees, IEHP team members, or IEHP members—and to provide an approximate number of persons whose information will be shared. This assessment aligns with IEHP's initiative to execute Every Door Direct Mail (EDDM) campaigns promoting Colorectal Cancer screening events across San Bernardino and Riverside counties in California, which may require contractors to access member contact information and demographic data to target underserved, diverse populations including Medi-Cal eligible members and Spanish-speaking communities.
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Text version
Section A: IEHP Contact Information
IEHP Department(s) Using Service or Vendor
IEHP Point of Contact Name
IEHP Point of Contact Title
IEHP Point of Contact Extension
Section B: 3rd Party / Vendor Contact Information
Company Name:
Company Address:
Company Web Site:
Primary Contact Name:
Primary Contact phone number:
Primary Contact email address:
Estimated Start Date
Estimated End Date
Section C: Services Provided to IEHP (Please give detailed explanation)
Section D: How is/ will sensitive information be transmitted, received, created/ maintained between IEHP & 3rd Party/ Vendor? (Please give detailed explanation)
Section E: Will 3rd party/ Vendor use offshore resources/ subcontractor(s)/ have a global workforce? If Yes, please explain in detail regarding country/ countries & services that require this.
IEHP Da t a Sha r ing Ass e ssment F o r m
Section F: Identify the types of information that will be received, viewed, used, disclosed or handled by vendor
Personally Identifiable Information (PII)
WHO IS THE DATA ABOUT?
| IEHP |
| IEHP Team |
| IEHP |
| Members |
| Members |
| Providers |
Full first name
Full last name
Complete addresses smaller than a state
Date of Birth
Phone numbers
Fax numbers
Email addresses
Social Security numbers
Member health plan ID number
Banking or Financial accounts
Driver’s License numbers
Vehicle identifiers and serial numbers, including license plate numbers
Individual's Website URLs
Internet Protocol (IP) address numbers
Biometric identifiers, including finger, retinal and voice prints
Full face photographic images
Any other unique number characteristic or code directly related to an individual not listed above
Medical or Behavioral Health Information
WHO IS THE DATA ABOUT?
IEHP
IEHP Team Members
Members
Medical information including diagnosis, admission \ discharge dates, healthcare treatment, medical history, medical records, etc.
Prescriptions
Healthcare payment information including claims, bills, receipts and explanation of benefits
Ancillary services including x-rays and labs
Data or information related to the provision of health care to an individual not listed above
Section G: Number of persons information being shared Approximate number of persons whose information will be viewed, used, disclosed or handled
File details come from the government source that posted it. Updated .