Appendix H.docx
DOCX document 42 KB Posted
- Solicitation number
- RFSQ-BHS-FY25-0066
- Issued by
- Santa Clara County, California
About this file
This is an Appendix H Electronic Health Record (EHR) Status Questionnaire for the County of Santa Clara, Behavioral Health Services Department, issued under RFSQ-BHS-FY25-0066 for Children, Youth, and Family System of Care Services. The questionnaire requires offerors to disclose their current EHR vendor and platform, assess compatibility with Netsmart's myAvatar system through Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API), and confirm capability to produce 837 billing files or manage contracts with vendors to produce such files. Offerors must identify which implementation type of myAvatar best suits their organization, choose from options including Provider Connect Enterprise (PCE), Provider Connect NX (PCNX) with 837 billing, PCNX with non-837 billing using Fast Service Entry, or PCNX without billing setup for data collection only. The questionnaire distinguishes between existing County-contracted providers and new offerors, with branching logic that directs respondents to answer specific questions based on their current status and existing myAvatar implementation.
The questionnaire requires offerors to assess resource availability to complete implementation within specified timeframes: approximately 3-4 months for PCE, 2 months for PCNX with 837 billing, 6 weeks for PCNX with non-837 billing, and 4 weeks for PCNX without billing setup. Offerors must provide a detailed implementation plan for myAvatar with County support through weekly go-live preparation meetings and designate primary EHR-related contacts for ongoing communication. All statements, answers, and representations must be submitted under penalty of perjury, with authorization by a duly designated representative. The questionnaire emphasizes that omissions, inaccuracies, or misstatements may result in rejection of the response in whole or in part.
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Text version
APPENDIX H
County of Santa Clara – Behavioral Health Services Department RFSQ-BHS-FY25-0066: Children, Youth, and Family 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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