Appendix H.docx
DOCX document 39 KB Posted
- Attached to
- Adult and Older Adult System of Care Services
- Solicitation number
- RFSQ-BHS-FY23-0210
- Issued by
- Santa Clara County, San Diego City, California
About this file
This is an Electronic Health Record (EHR) Status Questionnaire appendix for the County of Santa Clara Behavioral Health Services Department's RFSQ-BHS-FY23-0210 solicitation for Adult and Older Adult System of Care Services. The questionnaire is designed to assess offerors' EHR capabilities and readiness to integrate with the County's myAvatar system through Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API). Offerors must provide detailed information about their current EHR vendor and platform, their system's compatibility with Netsmart's myAvatar Provider Connect Enterprise (PCE) implementation, and their capability to produce 837 billing files or manage contracts with vendors to do so on their behalf. The questionnaire branches responses based on whether offerors are existing County-contracted providers and whether they already use myAvatar, requiring different question sequences accordingly.
The questionnaire addresses implementation requirements and timelines, with preparation periods ranging from approximately four weeks for myAvatar implementation without billing setup to three to four months for Provider Connect Enterprise. Offerors must demonstrate whether they possess adequate organizational resources to complete their selected implementation type prior to contract start date and provide detailed implementation plans with County support through weekly go-live preparation meetings. All statements submitted must be declared true and accurate under penalty of perjury, with authorization from a duly designated representative. The questionnaire requires offerors to designate specific contacts for all EHR-related communications with the County.
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Text version
APPENDIX H
County of Santa Clara – Behavioral Health Services Department RFSQ-BHS-FY23-0210: Adult and Older Adult System of Care Services
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 ☐ |
If yes: Answer Question 2 If no: Answer Questions 3-5 & 9-11 (skip questions 2 & 6-8)
| 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 & 11 (skip questions 9 & 10) If no: Answer Questions 3-5 & 9-11 (skip questions 6-8)
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? |
| ☐ PCE: about 3-4 months of prep |
☐ PCNX with 837 billing: about 2 months of prep ☐ PCNX with non-837 billing: about 6 weeks of prep ☐ PCNX without a billing setup: about 4 weeks of prep
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? |
| ☐ PCE: about 3-4 months of prep |
☐ PCNX with 837 billing: about 2 months of prep ☐ PCNX with non-837 billing: about 6 weeks of prep ☐ PCNX without a billing setup: about 4 weeks of prep
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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