Appendix H.docx
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- Solicitation number
- RFSQ-BHS-FY23-0225
- Issued by
- California
About this file
This is an Electronic Health Record (EHR) Status Questionnaire form issued by the County of Santa Clara Behavioral Health Services Department (BHSD) for RFSQ-BHS-FY23-0225, a Behavioral Health Treatment Facility Continuum of Care contract opportunity. The questionnaire requires offerors to provide detailed information regarding their current EHR capabilities and compatibility with the County's designated system, Netsmart's myAvatar platform. Offerors must disclose their existing relationship with the County, identify their EHR vendor and platform, and confirm their system's capability to integrate with myAvatar through Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API) using the Provider Connect Enterprise (PCE) implementation type. Additionally, offerors must verify their ability to produce 837 billing files or maintain contracts with vendors to generate these electronic claim files on their behalf. The form requires completion of questions specific to the offeror's current implementation status, with non-incumbent providers answering different question sets than existing County-contracted providers already using myAvatar.
The questionnaire requires offerors to assess their organizational resources and capacity to implement or transition to the appropriate myAvatar implementation type prior to contract commencement, with the County providing weekly go-live preparation meetings to support implementation. Offerors must indicate whether they have sufficient resources and staff to complete implementation within specified timeframes and must describe their detailed implementation plan. The form includes four implementation options: Provider Connect Enterprise (PCE), Provider Connect NX (PCNX) with 837 billing, Provider Connect NX (PCNX) with non-837 billing using Fast Service Entry, and Provider Connect NX (PCNX) without billing setup for data collection purposes only. All responses must be submitted with the proposal and must be complete, accurate, and truthful, with any omissions, inaccuracies, or misstatements potentially resulting in rejection of the response.
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Text version
APPENDIX H
County of Santa Clara – Behavioral Health Services Department RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care
OFFEROR’S ELECTRONIC HEALTH RECORD (EHR) STATUS
All EHR information requested in the form shall be furnished by Offeror and shall be submitted with the response. Statements shall be complete, accurate, and in the form requested. Any omissions, inaccuracies, or misstatements may be cause for the rejection of a response in whole or part.
| Question |
| Response |
| 1. Is Offeror an existing County-contracted Provider (CCP)? |
| YES ☐ NO ☐ |
| 2. Does Offeror already have a contract(s) with the County of Santa Clara in which myAvatar is already being used? |
| YES ☐ NO ☐ |
If yes:
· Answer Questions 3-8
If no:
· Answer Questions 3-5 & 8-10
3. Please provide the name of Offeror’s organizational EHR vendor and platform:
(ex. Netsmart, myAvatar, or N/A)
4. Does Offeror’s EHR have the capability of being certified with Netsmart’s myAvatar system through Fast Healthcare Interoperability Resources (FHIR) Application Programing Interface (API) allowing the implementation type of Provider Connect Enterprise (PCE)? [footnoteRef:1] [1: Offeror Electronic Health Records (EHR) would need to be compatible with FHIR if client data is to be electronically exchanged with the County of Santa Clara. The Offeror’s EHR vendor is responsible to assess the ability of their EHR to be compatible with FHIR and can reference the PCE Companion Guide (on the County’s partner site) that outlines the requirements necessary for integration.]
YES ☐ NO ☐
5. Does Offeror’s EHR have the capability to produce 837[footnoteRef:2] billing files or manages an active contract with an additional vendor to produce 837 billing files on Offeror’s organization’s behalf? [2: 837 billings files are electronic files that contain client and individual claim information. These are standard claim files and are comprised of individual claims that are then submitted electronically to be processed.]
YES ☐ NO ☐
| 6. What implementation of myAvatar is being used? |
| ☐ Provider Connect Enterprise (PCE) |
☐ Provider Connect NX (PCNX) with 837 billing ☐ Provider Connect NX (PCNX) with non-837 billing, using Fast Service Entry ☐ Provider Connect NX (PCNX) without a billing setup, completing forms solely for data collection.
| 7. Based off your understanding of the BHSD’s current myAvatar implementation type, will Offeror’s staff need a different (more enhanced) implementation type if awarded a contract for the services listed in this RFSQ? |
| YES ☐ NO ☐ |
If yes:
· Provide a reason:
Click or tap here to enter text.
· Proceed to question 8
If no:
· Proceed to question 11
| 8. Given the lengths of time provided below, does Offeror’s organization have enough resources to complete the need for a different (more enhanced) implementation type chosen in question 6 prior to the start of the contract? |
| YES ☐ NO ☐ |
| 9. Based off your understanding of the RFSQ parameters and your EHR capabilities, what type of implementation of myAvatar would best suit Offeror’s organization? |
| ☐ Provider Connect Enterprise (PCE) |
☐ Provider Connect NX (PCNX) with 837 billing ☐ Provider Connect NX (PCNX) with non-837 billing, using Fast Service Entry ☐ Provider Connect NX (PCNX) without a billing setup, completing forms solely for data collection.
| 10. Given the lengths of time provided below, would Offeror’s staff have enough resources to complete the selected implementation chosen in question 8 prior to the start of the contract? |
| YES ☐ NO ☐ |
| 11. With the County’s support in weekly go-live prep meetings, please describe Offeror’s organization’s plan to implement myAvatar. |
| Click or tap here to enter text. |
12. Please confirm the contact(s) the County shall contact for EHR related communications:
| NAME |
| TITLE |
The undersigned hereby declares under penalty of perjury that all statements, answers and representations made in this questionnaire are true and accurate, including all supplementary statements hereto attached. In the case of a corporate Offeror, the signature of one duly authorized representative is sufficient.
Signature
(Please print or type name)
Title
Signature
(Please print or type name)
Title
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