County of Nevada
Information & General Services Department
Purchasing Division
Request for Proposals
For
Nevada County Behavioral Health
Electronic Health Record System
Proposals Due
Wednesday, July 15, 2009 3:00 p.m. Pacific Time
at
Nevada County Purchasing Division
Eric Rood Administrative Center
950 Maidu Avenue
Nevada City, California 95959
Pre-proposal Conference
Tuesday, June 23, 2009 at 10:00 a.m.
at
Eric Rood Administrative Center
950 Maidu Avenue
Nevada City, California 95959
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 2 of 45
Table of Contents
1
SUMMARY ............................................................................................................................................................ 2
2
CONTRACT AWARD SCHEDULE.................................................................................................................... 3
3
GENERAL CONDITIONS ................................................................................................................................... 3
4
BACKGROUND AND DESCRIPTION OF CURRENT SERVICES .............................................................. 4
5
SERVICES REQUIRED ...................................................................................................................................... 8
6
PROPOSAL CONTENT AND FORMAT REQUIREMENTS ........................................................................ 22
7
SELECTION PROCEDURES ............................................................................................................................ 23
8
INQUIRIES .......................................................................................................................................................... 23
ATTACHMENT A - PERSONAL SERVICES CONTRACT (SAMPLE)................................................................ 24
ATTACHMENT B – PROPOSAL COVER SHEET ................................................................................................. 30
ATTACHMENT C – CURRENT SYSTEM DIAGRAM ............................................................................................ 31
ATTACHMENT D – DATA ELEMENT REQUIREMENTS ..................................................................................... 32
ATTACHMENT E – REPORT LISTING ................................................................................................................... 33
1
SUMMARY
The Nevada County Purchasing Agent, on behalf of the Department of Behavioral Health, hereinafter
collectively referred to as “County”, is requesting proposals from qualified providers for a fully integrated,
comprehensive Behavioral Health Electronic Health Records System (BH-EHRS). To qualify as a
provider for this RFP, the responder must have responded to the State Department of Mental Health
Request for Information for Electronic Health Record Systems and been found responsive to the State’s
requirements for such a system.
Nevada County anticipates receiving funds from the Mental Health Services Act, Capital Facilities and
Technological Needs Component for award and implementation of this project. Award of this contract is
contingent upon receiving these funds from the State of California.
This document uses the term “client” interchangeably with the term consumer and patient. Due to
databases and data fields in current systems that use “client,” Nevada County chose not to use the term
consumer to avoid confusion with terminology. For example, the CSI (Client and Service Information),
CCN (County Client Number) and CIN (Client Identification Number) are terms that cannot be changed to
support preferred terminology of consumer.
The term “offeror” as used herein shall refer to providers submitting proposals in response to this Request
for Proposals (RFP). The term “Contractor” or “Provider” is also used to describe the successful offeror(s)
in the context of providing services under a contract resulting from this RFP.
This document is available electronically to facilitate easier response. The electronic copy may be
downloaded from www.mynevadacounty.com/purchasing. Potential offerors must register with the County
in order to be notified of addenda and other notices. To register, please send an email to
Gerry.Benson@co.nevada.ca.us “Behavioral Health Electronic Record System RFP Registration” in the
subject field. If you do not receive a reply to this email indicating that you have been registered, please
call 530-265-1692.
All responses received in response to this RFP will be evaluated on the criteria described herein.
Sealed proposal responses must be clearly marked “PROPOSAL – Behavioral Health Electronic Record
System” and must include all elements described in the PROPOSAL CONTENT AND FORMAT
REQUIREMENTS section of this RFP. One (1) electronic copy, one (1) original and four (4) paper copies
of the proposal must be delivered to the address below before time and date requirements listed in the
CONTRACT AWARD SCHEDULE section of this RFP. The County will not be responsible for proposals
delivered to a person or location other than that specified herein, and reliance on the postal service will
not excuse late proposals.
Purchasing Division
County of Nevada
950 Maidu Avenue
Nevada City, CA 95959
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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Any amendment or addendum to this RFP is valid only if in writing and issued by the County of Nevada
Purchasing Agent.
A pre-proposal conference will be held in the Eric Rood Administrative Center in Nevada City at the time
and date listed in the CONTRACT AWARD SCHEDULE. Attendance at this conference is not required.
Questions and answers discussed at the conference will be documented and delivered to all potential
offerors who have registered as described above. Questions or requests for clarification of this Request
for Proposals may be submitted in writing in lieu of attending the pre-proposal conference, but must be
submitted no later than the time and date listed in the CONTRACT AWARD SCHEDULE. Responses to
written questions will be included in the published responses to questions arising at the conference.
The County reserves the right to decline to respond to any questions if, in the County’s assessment, the
information cannot be obtained and shared with all potential offerors in a timely manner.
2
3
CONTRACT AWARD SCHEDULE
Publish RFP
June 4, 2009
Pre-proposal Conference
Tuesday, June 23, 2009 at 10:00 a.m.
Deadline for Questions
Thursday, June 25, 2009 at 5:00 p.m.
RFP Submission Deadline
Wednesday, July 15, 2009 at 3:00 p.m.
Contract Approval (tentative)
September 22, 2009
Services to Begin (tentative)
October 1, 2009
GENERAL CONDITIONS
3.1
Prime Responsibility: The selected Contractor will be required to assume full responsibility for all
services and activities offered in its proposal, whether or not provided directly. Further, the County
will consider the selected Contractor to be the sole point of contact with regard to contractual
matters, including payment of any and all charges resulting from the contract.
3.2
Assurance: Any contract awarded under this RFP must be carried out in full compliance with Title VI
and VII of the Civil Rights Act of 1964 as amended, and Section 504 of the Rehabilitation Act of
1973 as amended. The Provider must guarantee that services provided will be performed in
compliance with all applicable county, state and federal laws and regulations pertinent to this
project. Prior to executing an agreement the Provider will be required to provide evidence
substantiating the necessary skill to perform the duties through the submission of references.
3.3
The Health Insurance Portability and Accountability Act of 1996 (Public Law 104-199 (HIPAA): Any
contract awarded under this RFP must comply with the requirement of 42 U.S.C. §§ 1171 et seq.,
Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its subsequent
amendments, related to Protected Health Information (PHI), in performing any task or activity
related to this Agreement.
3.4
Independent Contractor: In performance of the work, duties and obligations assumed by the offeror,
it is mutually understood and agreed that the offeror, including any and all of the offeror’s officers,
agents and employees, will at all times be acting and performing in an independent capacity and not
as an officer, agent, servant, employee, joint venture, partner or associate of the COUNTY.
3.5
Vendors may submit alternate proposals. Alternate proposals shall be clearly marked as such.
3.6
Nevada County prohibits discrimination in employment or in the provision of services because of
race, color, religion, religious creed, sex, age, marital status, ancestry, national origin, political
affiliation, physical disability or medical condition. This clause does not require the hiring of
unqualified persons.
3.7
The County reserves the right to reject any and all proposals, to negotiate specific terms, conditions,
compensation, and provisions on any contracts that may arise from this solicitation; to waive any
informalities or irregularities in the proposals; and to accept the proposal(s) that appear(s) to be in
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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the best interest of the County of Nevada. In determining and evaluating the proposals, costs will
not necessarily be the controlling factor. The experience of those who will be providing services
under the contract, quality, equality, efficiency, utility, suitability of the services offered, and the
reputation of applicants will be considered, along with other relevant factors.
3.8
Nevada County reserves the right to:
a.
b.
c.
d.
e.
f.
g.
3.9
Request clarification of any submitted information;
Not enter into any agreement;
Not to select any applicant;
Amend or cancel this process at any time;
Interview applicants prior to award and request additional information during the interview;
Award more than one contract if it is in the best interest of the County; and/or
Issue similar RFPs in the future.
Qualified vendors must be prepared to enter into the County’s standard Personal Services Contract,
a sample of which is attached as Exhibit A to this RFP. Please review the details of Exhibit A
carefully. By reference, it incorporates many standards, terms and conditions required as part of this
RFP. The County intends to award contracts substantially in the form of the sample agreement to
the selected vendor(s). Portions of this RFP and the vendor’s proposal may be made part of any
resultant contract and incorporated in the Contract.
3.10 Prior to commencement of services, the Contractor must provide evidence of the following
insurance coverages: Worker’s Compensation, Commercial General Liability (naming the County of
Nevada as additional insured), Comprehensive Business or Commercial Automobile Liability for
Owned Automobiles and Non-owned /Hired Automobiles, Errors and Omissions insurance; and
Professional Liability or Malpractice Insurance. The Contractor will be required to maintain the
required coverages, at its sole cost and expense, throughout the entire term and any subsequent
renewal terms of the contract.
3.11 Pursuant to the County’s Green Procurement and Sustainable Practices Policy, vendors are
requested to use recycled products and sustainable practices whenever possible in preparing their
response to this RFP, including using post-consumer recycled content paper and packaging
products, and copying on both sides of the paper.
4
BACKGROUND AND DESCRIPTION OF CURRENT SERVICES
4.1
BACKGROUND
Nevada County is seeking to replace our current Behavioral Health health records system with a fully
integrated electronic clinical health records system that can support both Mental Health and Alcohol and
Drug Programs. This system will optimize efficiency, eliminate redundancy, and improve service to
clients. The system will be used for registration, eligibility, billing, clinical assessment and treatment,
program monitoring, and reporting for management and state requirements, sharing clients, insurance
and associated data. Nevada County Behavioral Health has an active unique client count of
approximately 1,000 clients per year.
The Electronic Health Record System (EHRS) Project is structured with a phased approach. The first
phase procures the new electronic system and implements the replacement of the current electronic
billing system, including registration, eligibility, provider management, managed care, scheduling, claims
and all billing operations. The billing system replacement is expected to be in production by July 2010.
The second phase of the project is the replacement of the current clinical records system with a fully
integrated electronic system. The system will integrate with all aspects of the Phase I portion of the
project, including assessment, progress notes and treatment, and is estimated to be in production by July
2011.
Phases I & II of the project include the conversion of data from both Behavioral Health Programs (Mental
Health & Alcohol and Drug).
County of Nevada
4.2
RFP: Nevada County Behavioral Health - EHRS
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OBJECTIVES
The objectives of the project and new system include:
4.2.1
Replace current electronic and paper systems with a comprehensive electronic health
system that includes the following functionality:
a. Practice Management for Electronic Registration, Electronic Scheduling, Billing interface
with the State, Billing Interface with third party payors, ability to print paper claims for all
non-adjudicated third party payors and Billing Interface with Contract Providers.
b. Assessment, Authorization, Treatment Plans and Progress Notes.
c. Computerized Physician Order Entry (CPOE) for external Pharmacy and Lab.
d. External Provider interfaces.
4.2.2
Improved quality of care delivery through provision of a comprehensive client record
available in real time at the point of service.
4.2.3
Improved client outcomes through improved communication and continuity of care.
4.2.4
Reduction of duplicated information processing. Any data element should be entered or
updated one time to be available or corrected at each point in the electronic record at which
it appears.
4.2.5
Ability to support both Mental Health and the Alcohol and Drug Programs.
4.2.6
Maximization of revenues from all sources including Medi-Cal, Medicare, private insurance,
grants and patient billing within billing time constraints or limitations.
4.2.7
Improved utilization of services and data access for Quality Management.
4.2.8
Improved overall management efficiency and quality management through efficient
reporting and analysis of fiscal, operational, and service planning data.
4.2.9
Improve the efficiency and accuracy of information communicated amongst all
organizational sectors involved in client care.
4.2.10 Improved ability to electronically track and monitor multiple funding sources for reporting
requirements.
4.2.11 Maximization of data integration and access across all service modalities and programs.
4.2.12 Support, and the flexibility to expand, an enterprise-wide Common Data Dictionary as
required by the State of California Systems for data exchange and use by County for Data
Warehousing.
4.2.13 Integrated reporting tool for mandated and ad-hoc reports to facilitate the efficiency and
effective use of Count staff resources. Accessibility of all data elements, including text
fields, for query and reporting.
4.2.14 Fully electronic submission, receipt, and automated processing of healthcare finance
information in accordance with Short-Doyle, Short-Doyle Phase II, and Fee for Service
Medi-Cal (Managed Care Network Providers), Medicare, HIPAA, Share of Cost (SOC),
Uniform Method of Determining Ability to Pay (UMDAP) and other regulatory requirements
including Explanation of Benefits (EOB) and error report processing.
4.2.15 Ability to produce all mandated reports and submission of data including Client Services
Information (CSI), California Alcohol and Drug Outcomes Measurement (CalOMS), Data
Collection and Reporting (DCR), DMH Cost Report, and Alcohol and Drug Program Cost
Report.
4.2.16 The new system must be in accordance with the Request for Information (RFI)
requirements that were released in September 2008 by the California Department of Mental
Health (DMH) for a Behavioral Health Electronic Health Record System (BH-EHRS). This is
to ensure the long term collaboration and improvement of behavioral health services in the
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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state of California for Nevada County Behavioral Health Programs, contract providers, and
the client, family and vendor communities to allow for the exchange of client information
according to standards-based model interoperability. More detail can be found on the state
website at: http://www.dmh.cahwnet.gov/Prop_63/MHSA/Technology/RFI.asp
4.3
PROGRAM BACKGROUND AND OVERVIEW
Nevada County Behavioral Health is composed of two programs: the Mental Health Program
(MHP) and the Alcohol and Drug Program (ADP). Both of these programs rely on the critical
functionality of billing and clinical services for delivery of services to County consumers or clients.
Nevada County employs approximately 86 staff at various levels and skills required to support
these two programs.
The Nevada County MHP has an active unique client count of approximately 1,000 clients per year.
This program tracks and monitors contracts with external service providers delivering services to
Nevada County consumers. The service providers include:
a. Network Providers responsible for providing clinical services. There are approximately 29
Network Providers.
b. Organizational Outpatient Providers or Full Service Partnerships (a type of Mental Health
service involving a wide range of mental health services including case management, therapy
and psychiatry, and a full range of individuals who support the consumer in meeting treatment
goals including family members, teachers and mentors). There are approximately 5
Organizational Outpatient Providers that account for half of the County’s Medi-Cal claims.
c. Hospital Providers are mostly external providers outside of Nevada County. There are
approximately 21 external Hospital Providers.
The Nevada County ADP has an active unique client count of approximately 300 clients per year.
There are five ADP Non-Hospital Providers contracted to deliver services to Nevada County
consumers.
The current Nevada County billing system has separate databases for each program. The system
integrates the client ID at registration to maintain consistency between databases and for ease of
access to client data between databases. The current billing system serves as the primary source
for client registration, eligibility, all billing operations, appointment/scheduling, episode maintenance
(managed care), CSI data collection, CalOMS data collection, direct service entry, hospitalization
tracking, reports, and staff maintenance. The system tracks and monitors the activity of
approximately 62 County Reporting Units (R.U.s). The R.U.s are manually assigned alpha-numeric
strings. The first four numbers assign the R.U.’s legal entity number followed by one letter or
number of the county’s choosing. The R.U. designates funding sources, what procedure code sets
are to be used, the NPI numbers are included, if the R.U. is for tracking purposes only or if it is to
be billed to an outside source, what staff levels can bill to each procedure code and what
procedure code can be billed to what locations.
The billing system supports a multitude of billing cycles based on requirements of billing methods.
The client statements and “Out of County” billing are generated on the 5th of each month. The MediCal claims have (2) claim runs per month for each program (MHP & ADP). The MHP Medi-Cal
claim runs are scheduled runs, whereas the ADP claim runs are unscheduled runs based on
availability of data. Medicare and Private Insurance claims are processed on the 22nd of each
month.
The clinical system supporting both programs is mostly a manual paper system with a few MS
Access databases.
The Nevada County Department of Behavioral Health is geographically split amongst five sites; the
first four are located in Grass Valley. Clinical services are provided at all of these sites, as well as at
a number of other sites, including hospitals, shelters, and other residential and non-residential sites
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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in the community. The Nevada County Department of Behavioral Health employs forty-four (44)
permanent staff and approximately ten (10) temporary staff.
a. The Crown Point Office serves as the Headquarters for the department and hosts core
department business services including a centralized administration, quality management,
claims, billing, reporting and support services. This site serves as the primary location for
County Adult Mental Health Services and Alcohol and Drug Services. This facility has
approximately thirty-four (34) working staff at various levels and skills.
b. The Laura Wilcox Office serves as the primary site for Children’s Mental Health Services with
thirteen (13) staff.
c. The CalWORKS Office serves as an Adult Mental Health facility with services supported by one
department staff.
d. The Odyssey House serves as a Transitional Adult Housing Facility and is the operations site
for the County Crisis Center, with services supporting both adults and children.
e. The Truckee Office is the only out of town facility and is the only site housing both MHP (adult &
children) and ADP.
4.4
Overview of Nevada County’s Current Technical Environment
The current record system is a mixture of electronic data processing and manual processing
consisting:
4.4.1
InSyst – This is a dual database architecture housed on a legacy Timeshared VAX-VMS
platform delivering the current electronic billing system. Nevada County contracts with The
Echo Group to host, manage, and provide dedicated application support for two billing
databases (the MHP database and the ADP database), including a network connection to
the Echo Group system and a back-end frame relay network connection to the State of
California’s Data Center housing the Department of Mental Health’s information system.
The ADP database is 180 mb in size, including data storage. The MHP database is 1.3 gb
in size including data storage.
4.4.2
The Clinical system is mostly a paper process system with two small Access databases.
The paper processes and system is a multitude of client charts and the information stored
within each of the charts. The two Access databases have specific functionality with
limitations on simultaneous user access:
a. The Progress Notes database 5,568 kbis used mostly by Crown Point clinical staff to
enter progress notes, edit progress notes, and to create Event Monitoring Form (EMF)
Reports. This database contains all the current initial contact information such as
contact and statistical information about the consumer, callback dates and results,
assessment information and services. The historical data within this database goes
back to 2007. An older database (Initial Contact Front End database) stores historical
data prior to 2005.
b. The Treatment Plan database (640 kb)is used mostly by Crown Point clinical staff to
check on authorizations, enter treatment plans, enter assessments, check insurance
status for getting consumer MediCal services, track case management workload, and
to create monthly, annual, and 5 year assessment plans.
The current Clinical Access databases are limited to staff access located at the Crown Point
site and primarily used for Adult Services data. The Laura Wilcox site uses Excel spreadsheets
to record data for Children’s Services. The Truckee site uses Excel spreadsheets for both Adult
& Children’s Services data entry.
Nevada County would like the new system to include the functionality of both Access
databases, storing and distinguishing data for both Adult and Children’s services. This new
system must be accessible to all sites for data entry and updates.
The InSyst system is accessed by all sites and has a critical role in delivering services. These
sites traverse the County fiber Network to the County Data Center where they are routed to the
dedicated Echo T1 network connection and onto the appropriate database. The back-end
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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Frame Relay connection to the State’s Information Systems is used for State reporting and
eligibility look-ups.
Access and usage for the InSyst databases varies amongst remote sites. The Crown Point site
staff is the data entry (read, write, and update) site for each database. The Laura Wilcox site
performs data entry (read, write, and update) and look-up (read only) for Children’s Services.
The Odyssey House, CalWORKS, and Truckee sites all perform data look-up (read only)
relying on the Crown Point site for Adult Services data entry and Laura Wilcox site for
Children’s Services data entry.
Some of the access is remote via mobile links.
Attachment C is a network diagram of the current InSyst system.
5
SERVICES REQUIRED
5.1
Description of Two Models Required in Proposals
Nevada County has identified two service models that offeror responses must address. Responses
are to identify the “Pros” and “Cons” to each model as it fits within their business services. Those
submitting responses for each model will be given additional weight during evaluations.
MODEL #1 – Full Service Model:
This is a system housed at the vendor site and includes the following support services. Please
include any needed services and detail not listed below when providing the proposal for Model #1.
a. OS Hardware, Software, and Storage
b. Network Services and connections to State Datacenter systems
c. BH-EHRS Application software, database, client software, etc. installation and maintenance
d. IT Support for everything
e. Business Analyst to help support and ensure compliance with State requirements
f. This proposal is to come with an all inclusive cost model. Annual maintenance costs including
vendor staff resources based on estimated support hours.
MODEL #2: - COUNTY HOSTED – Vendor Software Package
This is a system where the County houses and supports the system infrastructure. The application
roles and responsibilities are to be separated and identified in the proposal. Following is a sample of
the Roles and Responsibilities. The Proposal can vary in detail from this example, but must detail
the division of services and costs associated with each feature so that the County can clearly
understand the cost impact for outsourcing these services. Discounts offered for packaging
services can also be included as appropriate. Specify Staffing Details in Pros and Cons Section of
requirements Section.
1. County IGS Support and Services:
a. OS Hardware, Software, and Storage
b. Network Services and connections to State Datacenter systems
c. BH-EHRS Application Support for the database, client software, reports (adhoc or special).
2. Vendor Support and Services:
a. BH-EHRS Software development and installation
b. BH-EHRS Software support only (annual maintenance contract). IGS would interact with
the contracted vendor IT support for problem resolution and fixes.
3. NCBH Support and Services:
a. Business Analyst for State Compliance oversight
County of Nevada
5.2
RFP: Nevada County Behavioral Health - EHRS
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System Technical Requirements and Service Requirements
5.2.1
System design and architecture requirements:
a. The platforms must be separated based on service and functionality supporting a tiered
architecture distinguishing between web services and the application or database.
b. Environments must be separated to support independent processing for testing,
training, and production.
c.
The test environment will be used for development and testing of enhancements and
upgrades to the production environment.
d. The training environment will be used for training and staff practice.
e. Environments must be maintained synchronously.
f.
Operating Systems must be Windows compatible with the latest versions and security
patches.
g. Databases must be Windows SQL compatible enabling the County to collect data for
use in County Data Mart.
h. The proposed network architecture must connect multiple county sites to the State
Datacenter Network at speeds no less than 1.544 mbps.
5.2.2
i.
The proposed network must follow current HIPAA and State security policies and
practices for data transport including encryption.
j.
Provide a replication environment to permit extensive reporting and upload tasks to
various enterprise applications without impacting production environment processing.
k.
The system must be designed and architected to support Business Resumption and
Disaster Recovery. Disaster Recovery must include a proposal for alternate site
processing. Responses must identify additional cost outside core services for Business
Resumption and Disaster Recovery.
The following systems and services are required:
a. Provide 24 x 7 technical support, with Help Desk tracking and monitoring.
b. Provide training for appointed Information Systems and Behavioral Health staff to
optimize use of in-house resources for system administration and maintenance. Provide
a training version of the system to facilitate training at all sites. Provide administrative
level training to appointed departmental trainers.
c.
Provide recommendations on the skills and experience levels for in-house county
staffing levels required for installation and maintenance of the proposed system.
d. Provide for migration or conversion of data from the ECHO/InSyst system to the new
system. All the data in the InSyst system is necessary for the continuation of Behavioral
Health business. If such an import is not feasible, the vendor must indicate that in their
proposal and provide a plan for maintaining access to the business information
contained in the InSyst system. A general description of the specifications of each
module in Phase I and Phase II are outlined below. See Exhibit “D” for a listing of the
expected data elements in each module and the associated attributes. NCBH is
requiring dual system processing (current system parallel processing with the new
system) to assure no break in any business functions and availability of all client data.
e. Provide project management support for the duration of the project.
f.
Provide a payment plan and stated amount for the County to purchase the source code
should the Vendor go out of business and/or declare bankruptcy.
g. Provide, in print and on-line, a Manual of Operation for the whole system including
table structure and relationship maps.
County of Nevada
5.3
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Software Functional Requirements
5.3.1
Provide a fully integrated, flexible, comprehensive, and user-friendly health record tracking
system that includes registration, eligibility, provider management and scheduling,
authorizations, claims and billing, placement tracking, the development of a management
information system including reports, the clinical management system including
assessment, progress notes, and treatment as an integrated component.
5.3.2
Provide a “user-friendly” system that includes intuitive screen navigation, drop down menus
with intuitive information grouping, easy to find information, centralized client data,
requires data be entered only one-time or at one source location, automated screen
progression, minimal clicks for navigation, links to related screens or processes or modules,
time-out warning, and includes all functionality related to business practices of the
Behavioral Health Programs.
5.3.3
Provide a flexible and extensible Web enabled system using the most up to date technology
available.
5.3.4
Provide a scalable and flexible system of security on all modules that allows for client, field,
and screen level security by individual and group users. Provide audit logs for each module.
5.3.5
Provide the ability to create customized screen views, data entry forms, and reports
including the ability to add or change data field labels in the same functional areas.
5.3.6
Provide Billing, Eligibility, Management and Clinical modules that are HIPAA and California
compliant, by providing HIPAA compliant transaction and code set standards and compliant
security mechanisms. Provide scalable end-user security levels for complete access control.
5.3.7
State regulations require Behavioral Health to retain and continue to use the current client
identifier. The new system will have to retain and continue the current numbering system
or provide an automatic cross-reference for State reporting purposes.
5.3.8
The following must be in production by July 2010:
a. Provide a Client Registration module that will permit registration to take place at the
point of service. The Registration module must have the ability to search for clients by
various data elements. It must provide built-in alerts and warnings to avoid the creation
of duplicate records, merge records when duplicates are identified, and manage
changes to client registration information. The Registration module must manage cross
referencing of alias names and tracking of John/Jane Doe records.
b. Provide a client search engine with a consent function that will permit blocking of
record access when and if a client denies consent to release information or requests
information not be shared with specific individuals or agencies. This is a security feature
granting permissions to designated staff for access to confidential consumer records.
c.
Provide a Client Finance and Eligibility module. Finance and Eligibility requires the
ability to interface with State and/or Federal proof of eligibility (POE) systems, such as
CALMEDS. It also requires coordination of benefits (COB), and explanation of benefits
(EOB) for Medi-Cal, Medicare, and other 3rd party payers. The Finance and Eligibility
module must provide for management of client accounts as well as client billing and
invoicing. Client eligibility links to all components of a client record for the management
of share-of-cost adjudication and the coordination of billing services. The Client Finance
module provides capacity to track Medi-Cal expenditures for Alcohol and Drug Programs
and Mental Health clients, and provides for electronic uploads of eligibility information
to the State Medi-Cal systems as well as batch eligibility file updates. This module must
provide for maintenance and tracking of the full billing life cycle including edits,
corrections and audit response. Refer to the DMH Cost Reporting Manual and a
discussion of other financial system reporting requirements including the Federal
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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Uniform Reporting System in the California DMH document: Supporting Information
Technology Infrastructure for California Mental Health System Accountability.
d. Provide a Mental Health Managed Care module that addresses access and triage,
referrals, prior authorization of services, claims adjudication, fee for service Medi-Cal
tracking, provider payment, and re-billing of paid claims.
e. Provide a Swipe Card module capable of automatically populating multiple screens with
relevant data. This module must be capable of identifying current Medi-Cal, Medi-Care
and Private Insurance eligibles and automatically populating the appropriate screens
with POEs and other relevant data elements to capture the appropriate billing. This
same functionality must also be applicable for current Medicare eligible’s, and current
Private insurance carriers.
f.
Provide an Insurance module capable of tracking all payors relevant to a client, client
benefits, and insured person information including relationship to client. The Insurance
module must manage Private Pay, UMDAP, PFI requirements and parameters, as well
as facilitate billing of 3rd party payors. The insurance, or payor, module must
accommodate tracking of grant funded, capitation and wrap around services.
g. Provide a system of alerts and reminders based on workflow and client movement
through the system that will prompt clinicians and clerical personnel to enter complete
information, and to update information based on user defined schedules.
h. Provide a Billing module with the capacity to maximize State and Federal
reimbursement through the appropriate coordination of benefits and management of
eligibility files. This module must also have the flexibility to adapt to new State and
Federal billing requirements including compliance with all applicable HIPAA and
California regulations. Provide a mechanism to integrate the Short-Doyle Medi-Cal
electronic EOB (eEOB), claims adjustments, error corrections and void and replace
mechanisms into the billing process. This module must also have the ability to submit
monthly CSI and CalOMS reports.
i.
Provide integration with, or replacement of the current provider credentialing
management system, MedAdvantage credentialer and various small internal provider
databases. The Provider Management module must link to, or include, cultural
competency data, and contracts information. It must also link to Scheduling, Billing,
Claims, and Clinical modules.
j.
Provide a Resource Scheduling module capable of tracking client needs and provider
attributes to assure efficiencies in referrals for care. The Scheduling module should
include a bed utilization and management component that provides tracking of beds
and census based on facility attributes.
k.
Provide a placement tracking module capable of tracking, in real time, when and where
several different types of beds are available in order to expedite patient flow from one
level of care to another. This software requirement serves both in county and out of
county housing.
l.
Provide a Management Information module capable of generating a variety of client,
program or provider based and system based reports providing management decision
support and significant event notifications.
m. Provide the ability to create Ad-Hoc reports and generate canned reports.
5.3.9
The following must be in production by July 2011:
a. Provide an Electronic Clinical Record module for Mental Health and Substance Abuse
that permits each to retain individual confidentiality requirements. The Clinical Record
must be available at the point of service and must contain clinical management
information, including prescription medication management and diagnostic testing
information.
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b. Provide a Behavioral Health Clinical module with the capacity for tracking case
management across the entire array of treatment modalities, while creating template
and customized treatment plans, managing predefined mental health and Alcohol and
Drug Programs assessment tools, and providing protocol based decision support.
c.
The Clinical module must support Mental Health and Alcohol and Drug Programs
outcomes analysis, utilization review, and quality management standards. The Clinical
module should feed directly into--and drive--the Billing module in order to provide
accurate billing files without duplicate data entry. There must be the ability for
organizational providers to turn off this requirement to process billing. The clinical
module must link to appropriate coding validation tables to provide accurate billing,
quantifiable reporting and outcomes management.
d. Provide for innovations in client centric recordkeeping by providing surveys and selfassessment tools, such as symptom review and medication side effects review, that can
be made available to clients to promote self-assessment, in a web based format, that
can be maintained within the electronic client record and made available to clinicians at
the time of client review and interview.
e. Provide for linkages to various community-based agencies to enable exchange of
treatment related information such as prescription management and laboratory testing.
f.
Provide a Prescription Management module capable of maintaining comprehensive
client medication profiles and providing clinical decision support and alerts. This module
must be capable of creating labels from MD orders, creating inventory control logs, and
providing access to drug formulary information. This module must facilitate
documentation of medication administration and dispensing at the point of service.
g. Provide for a Laboratory Management module capable of reporting results of laboratory
tests providing clinical decision support and alerts.
h. Integrate the clinical record with registration, eligibility and client insurance, billing and
provider management and scheduling to provide a seamless record to clinical users
with the system of workflow alerts and reminders required to support and promote
sound clinical recordkeeping practices.
5.4
Specifications and Attributes
Following are general descriptions for the specifications of each module, Exhibit “D” is a listing of
the expected data elements within each module and the associated attributes. Exhibit “D” identifies
“Required Elements (RE) and Preferred Elements (PE). Responses are required to provide
responses for each element in regards to current availability, future availability and data available,
and cost for added element.
5.4.1
General System Specifications
The Behavioral Health Electronic Health Record ties client registration and eligibility
information to all aspects of the client record. The electronic record facilitates accurate
selection of the correct client record, without duplication, at each point in the client care
process. The registration and eligibility module captures and makes available, where
needed in the process, demographic and insurance coverage information. The clinical
information module triggers or generates authorization, claims, and billing functions without
duplication of data entry.
General system requirements are those aspects of the computer system that make it
workable for all end users of both Mental Health and Alcohol and Drug programs (ADP),
however security must only allow clients records to be reviewed from the program they are
associated with, e.g. a clinician from the Mental Health program cannot see the client’s
information from the ADP program, even though they may be enrolled in both.
Organizational providers will only have access to their client’s information. In general, the
system must have the ability for the user to access data from more than one program at a
time. All users will be required to use appropriate log-in names and passwords, all users will
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want to use familiar screen navigation techniques, and all applications used must provide
for levels of security and information protection mandated by HIPAA and consistent with the
California Counties Security Best Practices recommendations and California Medical
Records law. Users need the ability to create navigation and shortcuts to allow them to
minimize keystrokes and use their time efficiently.
Attachment D, General System Specifications describes the user interface for clinical staff,
administrative staff and other end users of the system. The system will provide basic
standard reporting functionality that will be common to all users. Data integrity must be
addressed for all levels of records and users, data archiving, disaster planning and
recovery, and system security.
Information systems storing or transmitting protected health information must provide for
compliance with all applicable HIPAA and California regulations.
System customization that is created specifically for the County needs to be retained when
upgrades and new releases are installed.
5.4.2
Registration Requirements and Specifications
The Registration module provides the basic client record upon which all components of the
Electronic Health Record System records are built. The Registration module must provide
easy to use, rapid access, at the point of service for every behavioral health program and
provider. Registration must be program neutral to allow global use of a single registration
component without compromising confidentiality of protected health information.
Registration provides for positive identification of a client and establishment or insertion of
the unique client identifier. It facilitates identification of payor sources for clients and
provides information required for accurate State, Federal, grantor, and ad hoc reporting.
Registration also provides the demographic information required for the provision and
analysis of culturally competent client services, and the recruitment of culturally competent
providers. User defined registration fields must link to mandated reporting and be included
in guarantees for meeting regulations. Validation checks are included with the registration
to check for Medi-Cal eligibility, NPI numbers, and other critical fields that ensures that data
flows efficiently.
The registration module must provide for view, add, edit, and delete functions for new and
existing registrations according to authorized security clearance. The Registration module
should permit assignment of permissions for view, add, edit, and delete at the field level,
based on location, individual, group, and role definitions. Registration is used by all of the
following:
a. Administrative support staff
b. Licensed and unlicensed clinical staff
c. Registration and Billing staff
The Registration module must provide a system of alerts and reminders based on workflow
and client movement through the system that will prompt clinicians and administrative
support personnel to enter complete information, and to update information based on user
defined schedules. The system must be able to identify variations in names such as aka
(also known as) and Soundex (sounds like).
Registration functionality is mandated by mental health and alcohol and drug treatment
standards and regulations. This functionality is regulated by County, State and Federal
governing agencies and is necessary for the generation of mental health and alcohol and
drug revenues. It is directly related to the provision of comprehensive, quality patient care.
5.4.3
Eligibility Specifications
It is the mission of Nevada County Behavioral Health to provide Mental Health and
Alcohol and Drug Abuse services to Nevada County residents. The Eligibility module is
fundamental to this mission. Included in the eligibility process is verification of residency,
determination of benefits for which a client may be eligible, the client’s relevant
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documentation of payor financial information and calculation of ability to pay and
determination of third party payor source(s) for which the client may be eligible.
Functionality to be provided in the Eligibility module includes the ability to separately assign
user permissions to view, add, edit, and delete information at the record, screen and field
levels. These functions, accessible at all end user locations and compliant with HIPAA
security regulations, will also operate in conjunction with levels of user authorization and
access. The following personnel will use the Eligibility module:
a.
b.
c.
d.
e.
Administrative Support Staff
Licensed and unlicensed clinical staff
Billing and Claims Staff
Fiscal Staff
Administrative and Quality Management staff
Currently, the systems and/or agencies used to serve as our eligibility component are:
InSyst, MEDS, EDS, DHS/SSI, Drug Medi-Cal, and the Drug Courts. Eligibility information is
integral to billing, reimbursements, and provider selection and provider payment. Client
eligibility information must be reassessed annually, or when client information changes.
Eligibility must be determined prior to service authorization and requires documentation of
Payor Financial Information (PFI). Medi-Cal eligibility records must be updated every month
for active clients.
Assumptions for the eligibility module:
a. Eligibility information will be processed in HIPAA compliant format.
b. State forms and data element requirements will remain consistent for Alcohol and Drug
and Mental Health programs.
c. System allows flexibility to change elements, definitions, and interface based on State
and other governing agency requirements.
5.4.4
Insurance Specifications
The Insurance Module is essential to Behavioral Health’s policy of maximizing 3rd party
payor source reimbursement. Approximately 85% of our clients are insured by Medi-Cal. It
is the largest source of Mental Health reimbursement. For Alcohol and Drug, Medi-Cal is
the only third party payor aside from several Federal and grant funded programs. An
essential component of the Insurance Module is that it must be capable of automatically
identifying, either manually or via swipe card, all of a client’s third party payor sources. It
must also be able to populate the appropriate system screen or screens with the data
elements necessary to properly bill the individual client’s guarantors.
Given that Behavioral Health clients often have Medi-Cal eligibility established after they
have applied, and are often times Medi-Cal eligible prior to the date of their actual
application, it is essential that electronic matches between the BH-EHRS data base and
official State and Federal databases are run as often as possible. These matches must not
only be able to capture retroactive eligibility by automatically populating the appropriate
data fields; they must also be able to identify partial matches, whose data is then formatted
into organizational reports. In the process, when eligibility information is retroactively
applied, the applicable Late Reason Code must be automatically written into the client
record to ensure maximized revenue reimbursement and alert sent to the billing system
administrator.
In addition to HIPAA compliance, the following functionality must be provided with the
Insurance Module: the ability to assign permissions to view, add, edit, and delete must be
available at the record, screen and field levels. All aspects of the record with relative
security must be accessible at all end user locations. The Insurance Module must operate
in conjunction with levels of user authorization and access, and each individual client must
be linked to his/her specific payor sources. Insurance eligibility information should be readily
available throughout the clinical record.
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The Insurance Module will be used by the following personnel:
a.
b.
c.
d.
e.
f.
g.
Administrative support staff
Treatment access programs
Clinical program staff
Pharmacy
Billing and claims staff
Quality management staff
Fiscal staff
The Insurance Module will:
a. Permit more than one insurance per client per time span
b. Provide for printed insurance form for client or guardian signature on Assignment of
Benefits
c. Provide for printed release of information for processing insurance, to be signed by the
client
d. Allow for tracking, viewing and reporting multiple payor/insurance data, including all
eligible payors for a given client. Provide for cascading or “waterfall” tracking in
accordance with insurance billing methodologies.
5.4.5
Authorization Requirements
An authorization is the documentation of approval of treatment ordered by a clinician or
practitioner based on an assessment of client needs. Except in very specific circumstances,
authorization by an approved clinician is required for payment of all non-emergent mental
health care claims or billing. An authorization must exist prior to processing of claims for
payment of all non-emergent mental health care. The authorization module may be used to
document treatment access requests and referrals as well as authorizations.
Processes required for authorization:
a. Authorization of in-house and contracted providers (i.e., Organizational or Network
providers) such as in-house med services or Turning Point ACT program.
b. Document dates, duration and mode of service, including in-house services are bundles
under “Mental Health Services” (e.g., individual therapy, rehabilitation, collateral),
versus contracted services that need the individual services separately authorized.
c. Frequency for In-house services if ”PRN” and by number of sessions for contract
providers except ACT services (e.g., Turning Point, Victor, etc.)
d. Notification to providers, responsible individuals, and clients of care authorized or
denied via automatically generated letter and reports.
e. Adjudication of claims received after validation of authorization
f. Reauthorization of care for contracted providers requires input into Outpatient Services
Treatment Authorization Request Screen.
Authorization functions:
a. Are based on the level of care determined to be consistent with medical necessity
criteria which have some required fields (annual Medical Necessity and Authorization
form).
b. Are integrated with the list of approved, contracted providers and provider rate
information (e.g., $50 per session)
c. Are integrated with the Insurance module (which includes any private insurance, not
MediCare, Medi-Cal, and CMSP).
d. Merge with member and provider demographic information to facilitate notifications.
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e. Are integrated directly with the Clinical module treatment plan and billing module.
The Authorization module must provide for view, add, edit, and delete functions for new and
existing authorizations according to authorized security clearance. The Authorization
module should use security rules for granting permissions to view, add, edit, and delete at
the record, screen and field levels, based on location, individual, group, and role definitions.
Authorizations are used by all of the following:
a. Administrative support staff
b. Licensed and unlicensed clinical staff
c. Billing and Claims staff
Authorization functionality is mandated by mental health managed care standards and
regulations; regulated by County, State and Federal governing agencies; necessary for
generation of mental health and alcohol and drug revenues; and directly related to provision
of comprehensive, quality patient care.
5.4.6
Billing and Claims Requirements and Specifications
The Billing and Claims Module is fundamental to revenue generation. The Billing supports
all financial functions for Electronic Health Record System including accounts receivable,
accounts payable, cost accounting and revenues. The complete billing and claims process
includes verification of provider authorization to provide services, provider rates,
certifications and credentials; verification of client residency and financial status; verification
of client eligibility for services; determination of the client’s third party payor sources; and
verification of billable services.
For the purposes of the Billing and Claims module, a provider is defined as the clinic,
program, or individual providing a client service.
NCBH generates processes and submits claims for reimbursement to State agencies,
Federal agencies, private insurance, grant-funded projects and other third party payors.
Mental Health Services receives adjudicated processes and pays claims from approved
providers who provide services to NCBH clients. Reimbursement to the providers is based
on State and Federal MediCaid guidelines. The claims must support adjudication of claims
against authorizations for service based on medical necessity, client eligibility, provider
attributes, and procedures billed. Billing and Claims processes must support and enforce
rules and requirements related to eligibility determination, coordination of benefits,
remittance advisement and explanations of benefits for each agency billed. Billing will be
integrated with progress notes however override processes may be needed. Together
Billing and Claims must interface to permit seamless rebilling of Fee for Service Medi-Cal
claims to Short-Doyle Medi-Cal while enforcing all applicable billing rules.
The Billing and Claims provides for Direct Data Entry (DDE) and EDI for HIPAA compliant
electronic billing functions. DDE and EDI enforce all billing, COB and payment processing
regulations. This module should be able to generate claims adjudication letters to providers,
manage bundled services and service payment hierarchy.
The Billing and Claims Module must provide for view, add, edit, and delete functions for
new and existing records according to authorized security clearance. This module should
use security rules to grant permissions to view, add, edit, and delete at the record level and
field level, based on location, individual, group, and role definitions. The Billing and Claims
Module will be used by the following:
a.
b.
c.
d.
Administrative support staff
Billing and claims staff
Provider Relations
Fiscal staff
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e. Quality management staff
Billing and Claims functionality is mandated by mental health manage care and Alcohol and
Drug standards and regulations; regulated by County, State and Federal governing
agencies; necessary for generation of mental health and alcohol and drug revenues;
directly related to provision of comprehensive, quality patient care.
Assumptions for the Billing and Claims Module:
a. Billing and Claims information will be provided in HIPAA and California compliant format
b. The Billing and Claims Module will allow flexibility to change elements, definitions, and
interfaces based on County, State and other governing agency requirements
c. The Billing and Claims Module will allows for tracking, viewing and reporting—for a
given client—status of a claim at each stage of the billing process, for multiple
payor/insurers, and “waterfall” tracking in accordance with standard billing
methodologies
This module must be run parallel with the existing ECHO/InSyst System until claims have
been successfully processed from start to finish in the new system. This includes insurance
companies/guarantors including Medi-Cal, Medicare, private insurance, clients and other
counties.
5.4.7
Provider and Entity Management
Entities providing services to, or supporting clients include individual network practitioners,
organizational providers, psychiatric hospitals, group homes and other treatment facilities,
residential facilities, Board and Care homes, insurers and other third party payors, schools,
and related support staff. Information regarding clinical provider demographics, licensing,
sites, and services is required for assignment of culturally competent client care as well as
for appropriate payment and reimbursement billing. Insurer information is required to insure
appropriate tracking of third party payor sources, billing and coordination of benefits.
The Entity Management module must provide for view, add, edit, and delete functions for
new and existing providers/entities according to authorized security clearance. The Entity
Management module should use security rules to grant permissions to view, add, edit, and
delete at the field level, based on location, individual, group, and role definitions. Entity
Management is used by all of the following:
a.
b.
c.
d.
Selected clinical personnel
Administrative support staff
Central Registration and Billing staff
Quality Management staff
The Entity Management module must provide a system of alerts and reminders based on
workflow and entity processing through the credentialing and contracting systems that will
prompt Provider Systems personnel to enter complete information, and to update
information based on user defined schedules.
Entity management functionality is mandated by mental health and alcohol and drug
treatment standards and regulations; regulated by County, State and Federal governing
agencies; necessary for generation of mental health and alcohol and drug revenues;
directly related to provision of comprehensive, quality patient care.
The purpose of the Entity Management module is to:
a.
b.
c.
d.
e.
f.
Identify approved programs/providers
Identify provider location
Identify type of services provided
Identify funding sources
Set and track rate schedules
Track clinician license requirements
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g.
h.
i.
j.
k.
l.
Link to credentialing process
Link to billing to ensure maximum reimbursement
Link to accounts payable to ensure accurate payment and account tracking
Link to clinical module to inform provider selection
Link to provider cultural competence information to inform provider selection
Facilitate audits and reporting to track contracts and Memoranda Of Understanding with
specialty providers
m. Track contracts and Memorandum of Understanding (MOU) with specialty providers
n. Clinician information will be electronically interfaced with the Entity Management
module
o. NCBH stores the clinician information in the current InSyst system. The practitioner
credentialing information is stored and maintained in a separate database owned by
Med Management. The new system must maintain and process clinician and
practitioner credentialing information within this module.
p. Practitioner credentialing may be provided as an integrated part of the proposed system
or through direct interface with, and support of, the existing Provider Systems
credentialing information system.
q. Contract information will be electronically interfaced with the Entity Management
module
r.
5.4.8
Contracts are managed and maintained by NCBH.
Resource Scheduling
In general, the Resource Scheduling module must have the ability to automatically schedule
appointments integrated with client/patient service records, permit different methods of
appointment scheduling, not limited to: location, unit of time, service, individual, group and
medication support. The module must have the capacity to generate a report for current
and future business days, permit simultaneous appointment scheduling for multiple
providers providing group support to consumers, hide appointments and entire case
information of a confidential case from all but authorized staff, ability to schedule by
providers and have the ability to override and intentionally double book. This module must:
a.
b.
c.
d.
Provide User Defined schedule of times when a clinician is available to see clients.
Allow for clinicians available times to be posted by other clinician personnel
Provide search capacity to identify available clinician time and clinician location.
Enable the clinician for whom an appointment is scheduled to be notified by two
methods: 1. Electronically via e-mail and, 2. Via hard copy.
e. Provide an audit report capability tracking staff who schedule appointments for clinician.
f. Enable the clinician to view the last person who booked the appointment.
g. Provide a printout in hard copy for the client identifying a) Clinician, b) Clinician’s
address, c) Clinician’s phone number, d) time of scheduled appointment, and e) a list of
relevant reminders for the client. Provide a roll-up schedule for clinic managers.
h. Enable all scheduling information to be archived.
i. Permit a tracking history to include the following information: a) client no-show b)
Clinician missed appointment and c) Clinician productivity.
j. Permit the identification of clinician time overlap.
k. Provide a user defined set of notices and alerts with a dialogue box for client specific
issues.
l. Provide linkage of this module to the Registration, Billing and Eligibility Modules.
5.4.9
Placement Requirements
Nevada County Behavioral Health needs to track all clients across all levels of care. Nevada
County needs to identify bed availability of adult residential facilities. Nevada County needs to
track the specific standard and patch rates of outside contracted Board and Care and IMD
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placements, and when necessary, any other rates we might negotiate based on individual
patient need. Board and Care costs need to be monitored along with client payments.
The Bed Management Module needs the capability to track capacity and to identify unoccupied
beds in Residential Treatment facilities. Bed authorizations as well as extensions and the
reason(s) why the extension was granted, must be provided within the capacity of this module.
The module must also provide identification capacity for clients with specials needs including
history of violence, and substance abusing.
Special needs accommodation is integral to our System of Care, and the Bed Management
Module must be able to identify which facilities can accommodate clients with special needs
while identifying the precise nature of those needs. The Bed Management Module will be
utilized by the following Behavioral Health personnel:
a. Case Managers and Licensed Clinical Staff
b. Administrative Staff
c. Facility Personnel
Nevada County has one adult housing facility, the Odyssey House. This module is required
for placement at this facility. Future requirements extend the reach of this module linking it
to out of county facilities. Nevada County currently tracks beds and rents of the out of
county facilities using and Excel spreadsheet. Nevada County desires the ability to use the
new system to enter the data for out of county facilities enabling the ability to track and
monitor rates of these housing facilities.
5.4.10 Quality Management and Research
The Quality Management (QM) module will provide for continuous quality assessment,
monitoring, problem resolution and reporting in all of the following functional areas:
5.4.10.1
Identify Quality Improvement Committee members
5.4.10.2
Record and store committee meeting minutes
5.4.10.3
Analyze Data
5.4.10.4
Monitor Programs
5.4.10.5
Measurement Domains
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
Outcomes – Client & Clinician
Evidence Based Practices and Service Strategies
Adverse Incidents
Client Satisfaction
Provider Satisfaction
Grievances / Appeals / Problem Resolution
Utilization Management & Control
Informed Consent
Access (waiting list)
Service Capacity
Program Review
Performance Improvement Projects
Credentialing Review
Demographics
Service Patterns
Denials of Service
5.4.10.6
Baseline Level of Functioning
5.4.10.7
Easily extract data for use in other statistical packages
5.4.10.8
Integrated perspective (different aspects of Gov. services i.e.: Mental Health*,
Alcohol and Drug*, Primary Care, Jails, Health at Home) *Absolutely Required
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5.4.10.9
Ability to link database easily with other Government services databases with
uniform coding, including mapping to the Federal Uniform Coding System
providing an integrated perspective (different aspects of Gov. services i.e.:
Mental Health, Alcohol and Drug, Primary Care, Jails, Health at Home).
5.4.10.10 Provides basis for standardized clinical assessment
5.4.10.11 Considers both providers and management needs
5.4.10.12 Address all regulatory bodies’ needs
5.4.10.13 Consider billing aspect
5.4.10.14 Retain historical data
5.4.10.15 Flags for discrepancies: data entry, review/analysis, duplicates
5.4.10.16 Confidentiality compliance (access)
5.4.10.17 Eliminate double databases at provider level (POE)
5.4.10.18 Flexibility to comply with state and federal edicts
Quality Management functionality is required across all BH information systems. QM
modules must provide for audit and reporting functionality at all levels of the client,
provider, and facility records. QM functions are assigned according to authorized security
clearances and do not include add, edit, or delete permissions. This module should use
security rules to grant permissions at the field level, based on location, individual, group,
and role definitions. The QM module is used by all of the following:
a. Quality Management
b. Administrative Support staff
c. Licensed and unlicensed clinical staff
Quality Management functionality is mandated by mental health and alcohol and drug
treatment standards and regulations; regulated by County, State and Federal governing
agencies; necessary for generation of regulation compliant mental health and alcohol and
drug revenues; directly related to provision of comprehensive, quality patient care.
5.4.11 Reporting Requirements
Integral to our new BH-EHRS will be the capacity for our End Users to access and print
reports according to their level of authorization. The Reporting Module is an integrative
query tool coupled with reporting and analysis capabilities that do not create a drain on the
production of data entry, billing, and clinical informatics. Although it is vital that the system
have a User Friendly reporting tool for customized needs, the pre-programmed, standard
reports, need to be quickly delivered. The data contained in the report is visually compatible
with easy, simple to read tables and charts that drill down or up to match the scope of
analysis required.
The Reporting Module will have easy to distribute reports in various formats, and have the
capacity to create and save reports online with flexible functionality like formatting, sharing,
and arithmetic functions. All system security will apply to the reporting module. The
following items are also necessary, “must have” features we need with this module:
a. Deliver data from multiple data sources; securely and confidentially with full HIPAA
compliance
b. Scalable to handle growing demand; from tens to thousands
c. Easy to deploy with minimal required training necessary to produce reports
d. Minimize unnecessary/under-utilized fields
e. Input masking to match the field type and validation to ensure data integrity.
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f.
A ‘totally automated Cost Report package’ allowing for the appropriate clinical and fiscal
data to be downloaded into a pre-formatted, State compliant Cost Report.
The Reporting Module will be utilized by the following:
a. Clinicians
b. Clinical managers
c. NCBH Director
d. Analysts
e. Finance and Fiscal Personnel Managers
f. Administrative Support Staff
g. Bill and Claims Staff
h. Fiscal Staff
i. Contract Personnel
Attachment “E” is a listing of the reports that will be required by Nevada County.
5.4.12 Clinical Record Requirements
Nevada County Behavioral Health has multiple sites throughout Nevada County with
different equipment and hardware capabilities. Client assessment, diagnosis and treatment
information is collected, verified, and processed at each point of service. Nonstandardization creates onerous administration, quality management, reporting, and billing
tasks. Lack of information creates inefficiencies in the provision of care and disrupts client
treatment and care management. Paper records create deficiencies in the legibility,
availability, and retrieve-ability of clinical records. At each site clinicians need rapid access
to reliable and accurate client history and treatment information that can be updated and
built upon to avoid redundancies and to enhance continuity of care. To facilitate care,
assessment, treatment and diagnosis information should be collected in standardized
formats.
At each point of care the client must re-register and provide all historical information to each
care provider. Clients need the ability to update registration information. Clients have a right
to have input into the treatment planning process and expect treatment plans to carry over
from one point of care to the next within the organization. Treatment goals and medications
need to be recognized, monitored, and adjusted by each provider of care to meet the
client’s changing status and needs. Medications should be monitored for efficacy and
adjusted when necessary, with established treatment goals in mind. Clients should receive
the same standard of care at each treatment facility throughout the organization.
Goals for the electronic health record include capture of the core of essential information
about a client that does not change, and make it available to all users at each point of
service. Related goals include all of the following essentials: minimize the time spent
documenting client information; eliminate redundancies created when clients receive
separate but overlapping evaluations at each point of service; improve the timeliness of
information communication among care providers and provide the information required to
assist the clinician in making the best care decisions for the client at each point of service.
The electronic health record must be available at the point of service and be unobtrusive in
the clinician-client encounter. It must present an interface that offers intuitive, interactive
objects recognizable to the clinical user regardless of computer literacy. It must
accommodate all levels of care providers in the mental health child, adult and geriatric care
settings. It must provide for single entry of the data elements needed at each point in the
system.
To be successful the clinical record must be part of a fully integrated system that
incorporates care management and authorization; billing, finance, and claims; client
eligibility and registration; resource scheduling; quality management and utilization review;
and administrative reporting. The complete clinical record will facilitate access to contracts
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 22 of 45
and clinician management information, prescription medication management, diagnostic
testing information, and data analysis and research systems. In the future, the clinical
record may incorporate links to inpatient records and other community mental health record
systems.
An ideal system will provide a means for clients to review and update their own registration
information, have input into certain clinical record information, and utilize such tools as online symptom self monitoring, satisfaction surveys, and clinician check-in. Client generated
information should be incorporated into the clinical record, scheduling and treatment
planning.
The Clinical module must provide for view, add, edit, and delete functions for new and
existing records according to authorized security clearance. This module should use
security rules to grant permissions to view, add, edit, and delete at the field level, based on
location, individual, group, and role definitions. The Clinical module is used by all of the
following:
a. Licensed and unlicensed clinical staff
b. Pharmacy
c. Quality Management
The Clinical module informs billing and claims and is informed by registration, eligibility and
entity management.
Clinical record functionality is mandated by mental health and alcohol and drug treatment
standards and regulations; regulated by County, State and Federal governing agencies;
necessary for generation of mental health and alcohol and drug revenues; directly related to
provision of comprehensive, quality patient care.
6
PROPOSAL CONTENT AND FORMAT REQUIREMENTS
Interested offerors shall submit one (1) electronic copy, one (1) original plus four (4) paper copies of their
proposal to Nevada County Purchasing Division, Eric Rood Administrative Center, 950 Maidu Ave,
Nevada City, CA 95959. Submissions that are hand-delivered may be brought to the Auditor-Controller’s
on the 2nd floor of the Rood Administrative Center.
Proposals shall be delivered no later than June 22, 2009 and shall contain at a minimum the following
items:
6.1
Cover Sheet (Attachment B) – 5 points
Complete and attach a Cover Sheet (Attachment B) to your proposal.
6.2
Qualifications of Vendor – 20 points
6.3
a. Provide customer references as of evidence of successful implementation of the state of
California system changes such as SDMC II, CSI and CalOMS.
b. Provide a letter or other documentation from the State Department of Mental Health
recognizing receipt and compliancy with their Request for Information for Electronic
Health Record Systems.
c. Provide a list of active customers in CA and what stage of implementation they are in
with each component of the system.
d. Provide characteristics of offeror, including the mission statement, uniqueness or
specialization, organizational structure, and qualifications of project team.
e. Include a copy of your most recent audited financial statements.
Description of Services – 50 points
Complete and submit Attachment D - Data Element Requirements. Provide narrative descriptions of
how the proposed system will address each element and meet the technical specifications.
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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Provide a detailed description of how your system and services will meet the requirements outlined
in sections 5.2 through 5.4 of this RFP. Information should be presented in a manner that will allow
reviewers to clearly distinguish required components and identify where required features can be
found.
Provide a checklist of available reports in the proposed system using the identified list of county
required reports on Attachment E.
Clearly identify Model #1 and Model #2 and present the information in a side by side format to allow
easy comparison. Include in the list of pros and cons for each model and an analysis of the
potential County IT staff requirements needed to support the system.
6.4
Project Management Plan – 10 points
The Contractor is expected to designate a Project Team with direct experience in the
implementation of the proposed data system. Responses should include resumes of proposed
Project Team including the Project Manager.
Include in your proposal a draft project plan for implementation, data conversion, training, and
acceptance testing. Describe your methods for controlling and revising the project plan. This should
include plans and requirements for risk identification and management, ongoing communication with
the County, and change orders. Describe the nature and level of involvement that you expect will be
required from County technical and end user staff during implementation of the system.
6.5
Proposed Project Costs – 15 points
Provide a proposed budget for each phase of the project, including all aspects of personnel,
hardware, license fees and any items related to the development and implementation of the system
for Nevada County.
Costing for Model #1 and Model #2 needs to be presented in a side by side format to allow easy
comparison of scope and cost.
7
SELECTION PROCEDURES
After an initial review of each of the proposals for completeness, the offerors submitting the most
highly rated proposals may be invited for an interview and a product demonstration prior to final
selection, to further elaborate on their proposals. The County reserves the right to award a contract
without holding interviews, in the event the written proposals provide a clear preference on the basis of
the criteria described.
No agreement with the County of Nevada is in effect until both parties have signed a contract.
8
INQUIRIES
Direct all inquiries regarding the proposal process or proposal submissions to:
Gerry Benson, Purchasing Analyst
Nevada County Purchasing Division
950 Maidu Avenue
Nevada City, CA 95959
(530) 265-1692
Gerry.Benson@co.nevada.ca.us
County of Nevada
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ATTACHMENT A - PERSONAL SERVICES CONTRACT (SAMPLE)
County of Nevada, California
This Personal Services Contract is made between t h e COUNTY OF NEVADA (herein "County"), and
Contractor’s Name
(herein “Contractor”), wherein County desires to retain a person or entity to provide the following
services, materials and products generally described as follows:
(§1)
Description of Services
SUMMARY OF MATERIAL TERMS
(§2)
Maximum Contract Price:
(§3)
Contract Beginning Date:
(§4)
Liquidated Damages:
09/01/2009
Contract
Date:
Termination 09/01/2011
INSURANCE POLICIES
Designate all required policies:
Req’d
(§6)
(§7)
Commercial General Liability ($1,000,000)
Automobile Liability ($1,000,000)
Personal Auto
Business Rated
Commercial Policy
(§8)
Worker’s Compensation
(§9)
Errors and Omissions ($1,000,000)
LICENSES
Designate all required licenses:
Not Req’d
X
X
X
X
X
X
(§14)
NOTICE & IDENTIFICATION
(§26)
Contractor:
County of Nevada:
950 Maidu Avenue
Nevada City, California 95959
Contact Person:
( 530 ) 265e-mail:
Fund:
101 - 5000 - 52150
Contact Person:
(
)
e-mail:
Fed Tax Id:
Contractor is a: (check all that apply)
Corporation:
Partnership:
Person:
Calif.,
Calif.,
Indiv.,
Other,
Other,
Dba,
EDD: Independent Contractor Worksheet Required:
HIPAA: Schedule of Required Provisions (Exhibit D):
LLC,
LLP,
Ass’n
Non-profit
Limited
Other
Yes
Yes
No
No
ATTACHMENTS
Designate all required attachments:
Exhibit A:
Exhibit B:
Exhibit C:
Exhibit D:
Schedule of Services (Provided by Contractor)
Schedule of Charges and Payments (Paid by County)
Schedule of Changes (Additions, Deletions & Amendments)
Schedule of HIPAA Provisions (Protected Health Information)
Req’d
Not Req’d
X
X
X
X
County of Nevada
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Terms
Each term of this Contract below specifically incorporates the information set forth in the Summary at
page one (1) above as to each respective section (§) therein, as the case may be.
Services
Scope of Services:
Contractor shall provide all of the services, materials and products (herein “Services”) generally
described in Exhibit "A", according to a performance schedule, if applicable, as set forth in said exhibit (herein
“Performance Schedule”) . If requested, Contractor agrees to serve as an expert witness for County in any third
party action or proceeding arising out of this Contract.
1.
Payment
Charges and Payments:
The charges (herein “Charges”) for furnishing the aforesaid Services under this Contract are set forth in
Exhibit "B", including, if applicable, hourly rates, unit pricing, and expense, mileage and cost limits. Said
Charges shall be presented monthly by invoice, and shall be due within thirty (30) days of receipt unless
payment is otherwise set forth in said Exhibit “B”, and shall remain in effect for the entire term of this Contract,
and any extension hereof. In no event will the cost to County for Services to be provided under this Contract,
including direct non-salary expenses, exceed the Maximum Contract Price set forth at §2, page one (1),
above.
2.
Time for Performance
Contract Term:
This Contract shall commence on the Contract Beginning Date set forth at §3, page one (1), above.
All Services required to be provided by this Contract shall be completed and ready for acceptance no later than
the Contract Termination Date set forth at §3, page one (1), above.
3.
4.
Liquidated Damages:
County and Contractor agree that damages to County due to delays in timely providing Services in
accordance with the aforesaid Performance Schedule and Contract Termination Date are impractical and
difficult to ascertain. Therefore, if §4 at page one (1) hereof shall indicate a daily amount as Liquidated
Damages, County shall have the right to assess said daily sum, not as a penalty, but as and for damages to
County due to delays in providing Services not in accordance with the said Performance Schedule, or later than
the Contract Termination Date (herein “Delay”). Liquidated Damages shall be offset against amounts owing to
Contractor, including retention sums.
To the extent that any Delay is a result of matters or circumstances wholly beyond the control of
Contractor, County may excuse said Liquidated Damages; provided however, that County may condition such
excuse upon Contractor having given prompt notice to County of such delay immediately by telephone and
thereafter by written explanation within a reasonable time. The time for Contractor’s performance shall be
extended by the period of delay, or such other period as County may elect.
5.
Time of the Essence:
Time is of the essence with respect to Contractor's performance under this Contract. Delay in meeting
the time commitments contemplated herein will result in the assessment of liquidated damages, if indicated at
§4 at page one (1), hereof. If Liquidated Damages are not so indicated, damages shall be as otherwise
provided by law.
Insurance
6.
Commercial General Liability Insurance: (County Resolution No. 90674)
If §6 at page one (1) hereof shall indicate a Commercial General Liability insurance policy is required,
Contractor shall promptly provide proof of such insurance evidenced by a certificate of insurance with properly
executed endorsements attached, which insurance shall include the following:
County of Nevada
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(i)
Broad form coverage for liability for death or bodily injury to a person or persons, and
for property damage, combined single limit coverage, in the minimum amount indicated at said
§6;
(ii)
An endorsement naming County as an additional insured under said policy, with
respect to claims or suits arising from the Services provided or the relationships created under
this Contract;
(iii)
A provision that said insurance shall be primary and other insurance maintained by the
County of Nevada shall be excess only and not contributing with Contractor’s insurance;
(iv)
A provision that said insurance shall provide for thirty (30) days written notice to County
of any termination or change in coverage protection, or reduction in coverage limits (except ten
(10) days notice for non-payment of premium).
7.
Automobile Liability Insurance: (County Resolution No. 90676)
If §7 at page one (1) hereof shall require either a Business Rated or a Commercial Automobile
Liability insurance policy, for each vehicle used including non-owned and hired automobiles, Contractor shall
promptly provide proof of such insurance evidenced by a certificate of insurance with properly executed
endorsements attached, which insurance shall include the following provisions:
(i)
Liability protection for death or bodily injury to a person or persons, property damage,
and uninsured and underinsured coverage, combined single limit coverage, in the minimum
amount indicated at said §7;
(ii)
An endorsement naming County as an additional insured under said policy, with
respect to claims or suits arising from the Services provided or the relationships created under
this Contract;
(iii)
A provision that said insurance shall be primary and other insurance maintained by the
County of Nevada shall be excess only and not contributing with Contractor’s insurance;
(iv)
A provision that said insurance shall provide for thirty (30) days written notice to County
of any termination or change in coverage protection, or reduction in coverage limits (except ten
(10) days notice for non-payment of premium).
If §7 at page one (1) hereof shall require a Personal Auto policy, for each vehicle used including nonowned and hired automobiles, Contractor shall promptly provide proof of such insurance in such amounts as
required by law, evidenced by a certificate of insurance, or other proof acceptable to County.
8.
Worker's Compensation: (County Resolution No. 90674)
If §8 at page one (1) hereof shall indicate a Worker’s Compensation insurance policy is required,
Contractor shall maintain said policy as required by law, and shall promptly provide proof of such insurance
evidenced by a certificate of insurance, or other documentation acceptable to County.
Before commencing to utilize employees in providing Services under this Contract, Contractor warrants
that it will comply with the provisions of the California Labor Code, requiring Contractor to be insured for
worker's compensation liability or to undertake a program of self-insurance therefore.
9.
Errors and Omissions:
If §9 at page one (1) hereof shall indicate Errors and Omissions insurance is required, Contractor
shall maintain either a professional liability or errors & omissions policy in the minimum amount indicated, and
shall promptly provide proof of such insurance evidenced by a certificate of insurance, or other documentation
acceptable to County.
10.
Miscellaneous Insurance Provisions: (County Resolution No. 90675)
All policies of insurance required by this Contract shall remain in full force and effect throughout the life
of this Contract and shall be payable on a "per occurrence" basis unless County specifically consents to "claims
made" coverage. If the County does consent to "claims made" coverage and if Contractor changes insurance
carriers during the term of this Contract or any extensions hereof, then Contractor shall carry prior acts
coverage.
Insurance afforded by the additional insured endorsement shall apply as primary insurance, and other
insurance maintained by County, its officers, agents and/or employees, shall be excess only and not
contributing with insurance required or provided under this agreement.
At all times, Contractor shall keep and maintain in full force and effect throughout the duration of this
Contract, policies of insurance required by this Contract which policies shall be issued by companies with a
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 27 of 45
Best’s Rating of B+ or higher (B+, B++, A-, A, A+ or A++), or a Best’s Financial Performance Rating (FPR) of 6
or higher (6, 7, 8 or 9) according to the current Best’s Key Rating Guide, or shall be issued by companies
approved by the County Risk Manager. In the event the Best’s Rating or Best’s FPR shall fall below the rating
required by this paragraph, Contractor shall be required to forthwith secure alternate policies which comply with
the rating required by this paragraph, or be in material breach of this Contract.
Failure to provide and maintain the insurance policies (including Best’s ratings), endorsements, or
certificates of insurance required by this Contract shall constitute a material breach of this agreement (herein
“Material Breach”); and, in addition to any other remedy available at law or otherwise, shall serve as a basis
upon which County may elect to suspend payments hereunder, or terminate this Contract, or both. (See §13,
¶2, below, as these provisions additionally apply to subcontractors.)
11.
Indemnity:
Nothing herein shall be construed as a limitation of Contractor’s liability, and Contractor shall indemnify,
defend and hold harmless the County and its officers, officials, employees, agents and volunteers from any and
all liabilities, claims, demands, damages, losses and expenses (including, without limitation, defense costs and
attorney fees of litigation) which result from the negligent act, willful misconduct, or error or omission of
Contractor, except such loss or damage which was caused by the sole negligence or willful misconduct of
County or its officers, officials, employees, agents and volunteers.
Personal Services
Contractor as Independent:
In providing services herein, Contractor, and the agents and employees thereof, shall act in an
independent capacity and as an independent contractor and not as agents or employees of County.
12.
13.
Assignment and Subcontracting:
Except as specifically provided herein, the rights, responsibilities, duties and Services to be performed
under this Contract are personal to the Contractor and may not be transferred, subcontracted, or assigned
without the prior written consent of County. Contractor shall not substitute nor replace any personnel for those
specifically named herein or in its proposal without the prior written consent of County.
Contractor shall cause and require each transferee, subcontractor and assignee to comply with the
insurance provisions set forth herein at §§6, 7, 8, 9 and 10, to the extent such insurance provisions are required
of Contractor under this Contract. Failure of Contractor to so cause and require such compliance by each
transferee, subcontractor and assignee shall constitute a Material Breach of this agreement, and, in addition to
any other remedy available at law or otherwise, shall serve as a basis upon which County may elect to suspend
payments hereunder, or terminate this Contract, or both.
14.
Licensing and Permits:
Contractor warrants (i) Contractor is qualified and competent to provide all Services under this contract;
(ii) Contractor and all employees of Contractor hold all necessary and appropriate licenses therefore, including
those licenses set forth at §14, page one (1) hereof; and, (iii) Contractor shall obtain, and remain in compliance
with, all permits necessary and appropriate to provide said Services. Contractor shall cause said licenses and
permits to be maintained throughout the life of this Contract. Failure to do so shall constitute a Material Breach
of this agreement, and, in addition to any other remedy available at law or otherwise, shall serve as a basis
upon which County may elect to suspend payments hereunder, or terminate this Contract, or both.
Public Contracts
Prevailing Wage and Apprentices:
To the extent made applicable by law, performance of this contract shall be in conformity with the
provisions of California Labor Code, Division 2, Part 7, Chapter 1, commencing with Section 1720 relating to
prevailing wages which must be paid to workers employed on a public work as defined in Labor Code §§ 1720,
et seq.; and shall be in conformity with Title 8 of the California Code of Regulations §§ 200 et seq., relating to
apprenticeship. Contractor shall comply with the provisions thereof at the commencement of Services to be
provided herein, and thereafter during the term of this Contract. A breach of the requirements of this section
shall be deemed a material breach of this contract A copy of the relevant prevailing wage as defined in Labor
Code §1770 et seq. is on file with the Department of Transportation, County of Nevada, 950 Maidu Avenue,
Nevada City, California 95959. Copies will be provided upon request.
15.
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 28 of 45
16.
Accessibility (County Resolution No. 00190):
It is the policy of the County of Nevada that all County services, programs, meetings, activities and
facilities shall be accessible to all persons, and shall be in compliance with the provisions of the Americans With
Disabilities Act and Title 24, California Code of Regulations. To the extent this Contract shall call for Contractor
to provide County contracted services directly to the public, Contractor shall certify that said direct Services are
and shall be accessible to all persons.
17.
Nondiscriminatory Employment:
In providing Services hereunder, Contractor shall not discriminate against any employee or applicant for
employment because of race, color, religion, age, sex, national origin, political affiliation, ancestry, marital status
or disability. This policy does not require the employment of unqualified persons.
18.
Prior Nevada County Employment (County Resolution No. 03-353):
Effective July 22, 2003, it is the policy of the County of Nevada that former members of the Board of
Supervisors, a former CEO, or a former Purchasing Agent, for a period of twelve (12) months following the last
day of employment, shall not enter into any relationship wherein that former employee or former Board member
receives direct remuneration from a legal entity that, during the last twelve (12) months of said employment or
Board member’s service, entered into a contract with, or received a grant from the County of Nevada. Provided
however, that this prohibition shall not apply to any employee that did not personally approve a contract with or
grant to said legal entity during the last twelve (12) months of said employment, and shall not apply when the
Board of Supervisors did not approve a contact with or grant to said legal entity during the last twelve (12)
months of said Board member’s service.
A violation of this policy shall subject Contractor to all of the remedies enumerated in said resolution
and as otherwise provided in law, which remedies shall include but not be limited to injunctive relief,
cancellation and voiding of this contract by County, a return of grant money, a cause of action for breach of
contract, and entitlement to costs and reasonable attorney fees in any action based upon a breach of contract
under this provision.
19.
Cost Disclosure:
In accordance with Government Code Section 7550, should a written report be prepared under or
required by the provisions of this Contract, Contractor agrees to state in a separate section of said report the
numbers and dollar amounts of all contracts and subcontracts relating to the preparation of said report
Default and Termination
Termination:
A Material Breach of this Contract pursuant to the terms hereof or otherwise, in addition to any other
remedy available at law or otherwise, shall serve as a basis upon which County may elect to immediately
suspend payments hereunder, or terminate this contract, or both, without notice.
If Contractor fails to timely provide in any manner the services materials and products required under
this Contract, or otherwise fails to promptly comply with the terms of this Contract, or violates any ordinance,
regulation or other law which applies to its performance herein, County may terminate this Contract by giving
five (5) days written notice to Contractor.
Either party may terminate this Contract for any reason, or without cause, by giving thirty (30) calendar
days written notice to the other, which notice shall be sent by registered mail in conformity with the notice
provisions, below. In the event of termination not the fault of the Contractor, the Contractor shall be paid for
services performed to the date of termination in accordance with the terms of this Contract. Contractor shall be
excused for failure to perform services herein if such performance is prevented by acts of God, strikes, labor
disputes or other forces over which the Contractor has no control.
County, upon giving sixty (60) calendar days written notice to Contractor, shall have the right to
terminate its obligations under this Contract at the end of any fiscal year if the County or the State of California,
as the case may be, does not appropriate funds sufficient to discharge County’s obligations coming due under
this contract.
20.
Miscellaneous
Books of Record and Audit Provision:
Contractor shall maintain complete records relating to this Contract for a period of five (5) years from
the completion of Services hereunder. Said records shall include but not be limited to proposals and all
21.
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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supporting documents, original entry books, canceled checks, receipts, invoices, payroll records including
subsistence, travel and field expenses, together with a general ledger itemizing all debits and credits
Contractor shall permit County to audit said records as well as such related records of any business
entity controlled by Contractor. Said audit may be conducted on Contractor's premises or at a location
designated by County, upon fifteen (15) days notice. Contractor shall promptly refund any moneys erroneously
charged and shall be liable for the costs of audit if the audit establishes an over-charged of five percent (5%) or
more of the Maximum Contract Price.
22.
Intellectual Property:
All original photographs, diagrams, plans, documents, information, reports, computer code and all
recordable media together with all copyright interests thereto (herein “Intellectual Property”), which concern or
relate to this Contract and which have been prepared by, for or submitted to Contractor, shall be the property of
County, and upon fifteen (15) days demand therefore, shall be promptly delivered to County without exception.
Provided however, for personal purposes only and not for commercial, economic or any other purpose,
Contractor may retain a copy of Contractor’s work product hereunder.
23.
Entire Agreement:
This Contract represents the entire agreement of the parties, and no representations have been made
or relied upon except as set forth herein. This Contract may be amended or modified only by written, fully
executed agreement of the parties.
24.
Jurisdiction and Venue:
This Contract shall be construed in accordance with the laws of the State of California and the parties
hereto agree that venue shall be in Nevada County, California.
25.
Compliance with Applicable Laws:
The Contractor shall comply with any and all federal, state and local laws, codes, ordinances, rules and
regulations which relate to, concern of affect the Services to be provided by this Contract.
26.
Notices:
This Contract shall be managed and administered on County’s behalf by the department and the
person set forth at §26, page one (1) of this Contract, and all invoices shall be submitted to and approved by
this Department. In addition to personal service, all notices may be given to County and to Contractor by first
class mail addressed as set forth at said §26 Said notices shall be deemed received the fifth (5th) day following
the date of mailing or the earlier date of personal service, as the case may be.
27.
Authority:
All individuals executing this Contract on behalf of Contractor represent and warrant that they are
authorized to execute and deliver this Contract on behalf of Contractor.
IN WITNESS WHEREOF, the parties have executed this Contract effective on the Beginning Date, above.
County of Nevada
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ATTACHMENT B – PROPOSAL COVER SHEET
Product Name:
Company Name & Address:
Federal Tax ID:
Contact Person:
Phone & Fax Numbers:
Email address:
REQUIRED CONTENT:
Note if Included (I), Not Included (NI) , or Partially Included (P) and explain reasons for missing content
Qualifications of Vendor
Provide evidence of a track record and responsive on time implementation of the state of
California system changes such as SDMC II, CSI and CalOMS.
Provide documentation of response to the State Department of Mental Health Request for
Information for Electronic Health Record Systems and that your product has been found to be
compliant with the State’s requirements for such a system.
Provide a list of active customers in CA and what stage of implementation they are in with each
component of the system.
Provide organization’s mission statement, uniqueness or specialization, organizational structure,
and qualifications of project team.
Include a copy of your most recent audited financial statements.
Description of Services
Complete and submit the Data Element Requirements form referenced and described in
Attachment D. Provide narrative descriptions when appropriate of how the provider will address
each element not included in the standard installation.
Provide a detailed description of services that are called out for in this RFP. Information should be
packaged to allow reviewers to clearly distinguish between required components and identify
where required features can be found.
The proposal needs to clearly identify Model #1 and Model #2 and present the information in a
side by side format to allow easy comparison. Include in the list of pros and cons for each model
an analysis of potential County IT staff requirements needed to support the system.
Project Management Plan
Designate a Project Manager with specific experience implementing the proposed data system.
Include in your proposal a draft project plan for implementation, data conversion, training, and
acceptance testing. Describe your methods for controlling and revising the project plan. This
should include plans and requirements for risk identification and management, ongoing
communication with the County, and change orders. Describe the nature and level of involvement
that you expect will be required from County technical and end user staff during implementation of
the system.
Proposed Project Costs
Provide a proposed budget for each phase of the project including all aspects of personnel,
hardware, license fees and any items related to the development and implementation of the
system for Nevada County.
Costing for Model #1 and Model #2 needs to be presented in a side by side format to allow easy
comparison of scope and cost.
_______________________________________
Signature of Authorized Representative
____________________
Date
Included
Not Included
Partial
County of Nevada
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ATTACHMENT C – CURRENT SYSTEM DIAGRAM
Nevada County
Insyst Network Diagram
Thursday, April 16, 2009
Joseph Center Truckee
Crown Point Site
Nevada County
Network
Laura Wilcox
Echo Site
nt
Point to Poi
T1
RagTyme
VAX Server
Line Printer
The Odyssey House
CalWorks
Mobile
Customer
Access
State Mainframe
State Frame Relay
Network
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
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ATTACHMENT D – DATA ELEMENT REQUIREMENTS
Instructions:
An Excel workbook file named BH-EHRS DATA ELEMENT REQUIREMENTS.xls can be found on the Nevada
County Website at www.mynevadacounty.com/purchasing then selecting ‘View our current Requests for
Proposals and bid results’, then selecting ‘Nevada County Behavioral Health Electronic Health Records System
RFP’ or by following this link (http://docs.co.nevada.ca.us/dsweb/View/Collection-54811).
Proposers must respond to each item in the BH-DATA ELEMENT REQUIREMENTS worksheet and attach the
completed worksheet to the proposal.
For each requested feature in each work sheet the Proposer must enter a rating and additional cost (if any)
for each feature listed. The ratings and their meaning are listed below:
Enter a rating of 2 if the proposed system currently has the requested feature in production at the time of this
proposal and enter any additional cost for this feature.
Enter a rating of 1 if a proposed system has the requested feature which will be available at a later date and
enter the estimated date and any additional cost for this function.
Note, a proposer must guarantee delivery within 12 months from implementation. Contract will include
firm due dates with assigned penalties and / or cancellations clauses.
Enter a rating of -2 if the proposed system does not have the requested feature in production at the time of this
proposal nor will the feature be available within 12 months.
Definition of Required and Preferred Elements
RE = Required Elements.
Functionality and data requirements are essential to business operation of Behavioral Health Services.
PE = Preferred Elements.
Functionality and data requirements are preferred to optimize efficiency and efficacy of the Behavioral Health
Information system.
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 33 of 45
ATTACHMENT E – REPORT LISTING
#
BH-EHRS Report Name
Description
1
Organizational Provider/Network
Provider Client Caseload
list of client, last name, first name, client
number, assigned organizational provider or
network provider, last service date, date of
birth, by adult versus children
2
Client Report by DSM-IV-R Axis I
diagnosis
3
Client Report by DSM-IV-R Axis
II diagnosis
list of client, last name, first name, client
number, DSM IV Axis I primary diagnosis
and secondary diagnosis, date of birth, by
adult versus children
list of client, last name, first name, client
number, DSM IV Axis II primary diagnosis,
date of birth, by adult versus children
4
5
Identify MediCal and Non-Medical
clients by RU
Outpatient Jail Services
List client name, last name, first name, client
number, MediCal Y/N, and RU
Unduplicated count of persons receiving
outpatient services within a jail facility within
a specific time frame.
6
SAMSHA stats
7
Audit Medi-Cal list
8
Address list
Active clients receiving services in an
outpatient or partial care setting by the
following breakdowns. Sex: Male, Female;
Age; 0-17; 18-64; 65+, Ethnicity, RACE,
Legal Status, Forensic
This is a list of our Dr. medical clients that
need to be audited, It has the client name and
#, service date, procedure code, time, and the
Dr. name and staff # so we can match clients
with Dr.
This report lists client names and addresses
for surveys the need to be mailed
9
Audit RGB
10
Medi-Cal
11
Truckee Doctor List
12
Treatment reauthorization list
(monthly)
This report lists services on clients to be
audited with staff #, staff name, date of
service, procedure code, time, what RU, the
staff # and name
This report lists Physician's clients that need
to be audited; includes client name and #,
service date, procedure code, time, and the
physician name and staff # to match clients
with physician.
This report lists of open clients for Truckee,
for both children and adults.
Fields include client name, client number,
date of last service, open date for the RU, .
This monthly report is based on the month the
person was admitted to RU across all years for
open clients.
Report
Number
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 34 of 45
13
Open client list
A report of all clients with an open episode.
Includes client number, client name, phone #,
opening date, therapist staff number, therapist
name, DOB, reporting unit, medical doctor's
staff number, and medical doctor's name.
14
Monthly Insurance Report
15
Unduplicated client count
16
Monthly Insurance Eligibility
Report
17
AB3632/Special 354 with client
detail
18
Turning Point's Data Entry
Verification Report
19
Treatment Plan Expire Report
20
Initial Contact Report
This report indicates lists all of the clients by
name, client number, insurance company,
insurance I.D. number, service period, all
reporting units number the client is open to,
date the insurance claim printed and the
amount of the insurance claim. This is a
comprehensive report indicating all claims
submitted for the month.
This report lists the number of clients with
open episodes in each reporting unit, and
provides an unduplicated count by Reporting
Unit.
This report indicates all of the clients in the
system with an open episode. The report
includes client name, client #, DOB, Financial
Acct. #, CMSP active or last date eligible,
Medicare, Medi-Cal, Last mo. Of Medi-Cal
eligibility, Insurance Payer #1, Insurance
Payer #2, Insurance Payer #3, Medi-Cal #,
Medicare#, Medicare Name, Resp. County
Code, R/U#, Monthly Income, Monthly
Income, CIN#, Episode Opening, Last
Service Date.
The report creates summary records on
service and cost data for direct and indirect
services. It lists the total units of service and
total charges for each combination of mode,
reporting unit, service function code,
procedure code, and service month/year, Org
Name, Patient Name,
Charge Amt, Staff Min., client’s name, client
number.
This report includes the clients name, client
number, reporting unit, service date,
procedure code, therapist, hours, minutes and
cost of service.
fields include name client number,
psychiatrist, Turning Point, Odyssey House,
COD, and treatment plans dates for med, case
management, therapy, separate reports for
each treatment plan expiration date, sorted by
oldest
Fields: last name, first name, insurance status,
initial date contact, current date, initial
contact, type of contact, phone number,
problem and background, outcome,
disposition comments, date of intake, staff
designated for intake, staff completing initial
contact
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 35 of 45
21
5 year reassess Report
name, client number, assessment date, med
treatment plan date, sorted by oldest
22
Remote list - Hospital
List of past hospitalization, including admit
date, last name, first name, client no.,
insurance status, facility, 5150 versus
voluntary, reason(s) for 5150, date of
discharge, placement, days referral, admin
days, COD, gender, age, date of post hosp
contact, 2nd follow up contact date, doctor's
apt, tabulate by facility for month, fiscal year,
and include cost per day
23
IMD List (Facility)
24
MediCal Monitoring Report
25
Contractor Service Detail Report
26
Contractor Service Summary
Report
date of admit, last name, first name, client
number, placement, type of placement, cost
per day, running total cost for fiscal year,
tabulate by facility over designated times, per
month, fiscal year
using fields from eligibility report, adding
fields for reason for no MediCal, disposition
of referral, exception status, reason for
exception
This is a detail report to include type of
service; direct/indirect, month the data entry
occurred, reporting unit #, reporting unit
name, procedure code, procedure description,
client name, client number, service date,
hours, minutes, total minutes, rate, staff
I.D.number and staff name.
This is a summary of Contractor Service
Detail Report. This indicates each procedure
code number, procedure code name, total
minutes entered for this procedure code, the
rate per minute, total billed amount.
27
Primary Staff Caseload Report
This report shows all clients currently
assigned to each clinician in a reporting unit.
It lists client name and number, episode
opening date, age, primary diagnosis, last
service date, and primary physician if one has
been assigned. It also lists other reporting
unit and staff who have open episodes for
each client. It indicates which case manager
has been assigned. It provides a total count for
each staff member.
PSP 100
28
Daily Service Audit Report
This report shows the services that each
clinician performed on the specified day. It
lists clinician, run date, clients served,
procedures, service date and service cost.
PSP 102
29
Indirect Services
This report lists detail Indirect Services or
Overhead services for each staff member for
each reporting unit. It includes the procedure,
the recipient, the service date, and the time
spent. It calculates total number of services
and total time for each staff member and for
each Reporting Unit.
PSP 104
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 36 of 45
30
Referral Completed Report-
This report lists, by provider, clients who have
been closed and referred to another provider
within the specified time period.
PSP 109
31
Referral Source Report
PSP 111
32
Insurance and Medicare
Receivables Summary
33
Insurance and Medicare
Receivable Details
34
Provider Staff Activity Analysis
Report
This report shows the number of referrals by
referral source for all open episodes, in order
to give the Clinic Manager an overview of
how clients are being referred to a clinic. It
provides a count and percentage rate for each
referral source.
This report lists receivables from one or more
insurance companies. It includes four aging
categories, such as 0-30 days, 31-60 days, 6190 days, 91-120 days, which local Operations
Staff can modify. It lists the total dollar
amount (rounded to the nearest dollar) and
number of claims in each aging category for
each insurance company name. It also
summarizes the total dollar amount and
number of claims for each company and for
all companies.
This report gives more detailed information
on the receivables. For each claim, it shows
whether the client is a crossover, and it lists
client number, client name, group and policy
number, reporting unit, program name, service
month and year, total amount claimed, and
date submitted.
This report lists the activity of each staff
person, by reporting unit. It shows the total
number performed and the total number of
hours used for each type of service.
35
Client Episode History Report
PSP 118
36
Absence of Service Report
This report lists all episodes for a client during
the past year. It shows the Reporting Unit,
Admission Date, Closing Date, Primary
Diagnosis, Primary Therapist, Physician, last
service date, and total units provided by the
RU.
This report lists clients with open episodes
who have not received any services within the
specified time period.
37
Program Caseload Report
This report lists all the clients with open cases
for each reporting unit. It includes client
number, name, opening date, age, primary
diagnosis, and primary staff.
PSP 121
38
Weekly Processing Report
PSP 125
39
Provider Balances Attributes
Report
The report shows all clients open in a
specified program during a specified week. It
is used by programs that use the Weekly
Service Entry Screen, typically at an IMD or
inpatient environment.
This report includes information on each
reporting unit’s operations and on the type of
services that each can provide.
MHS 115
MHS 116
PSP 117
PSP 119
MHS 127M.H. & AOD
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 37 of 45
40
Reporting Unit Master Listings
Report
This report creates four output files with
information about each reporting unit
PSP 129
41
Provider Service Summary Report
This report shows the total services, direct and
indirect, for all reporting units during the
specified time period. RUs are sorted by
region. This is an agency-wide report.
PSP 130
42
Reporting Unit Service Summary
By Provider
This report shows the total services by type
for the specified reporting unit during the
specified time period. This is a singlereporting-unit version. It generates a commadelimited file as well as a printed report
PSP 131
43
Report Users/Report Menu Report
PSP 137
44
Client Information face Sheet
45
Client Refund Due
46
Bill on Hold report
This report shows which reports have been
installed on the system, which menu each
report is on, and who has access to each
report.
This report is a summary description of a
client’s demographic and clinical history. It
can be placed in the chart as a face sheet, if
that is local policy.
This report lists all client payments in the
system that do not have client receivables to
apply against. These payments remain in to
post status. The report is sorted by
responsible party name. For each payment, it
shows the RP name, account number,
payment amount in To Post status, receipt
date of the payment, the most recent
deductible effective date, annual deductible
liability, liability balance, account balance,
last service date, last service reporting unit. It
also includes summary balances for previous
deductible liability periods.
This report lets users find all accounts that are
being suppressed for client billing. The report
includes account number, responsible party
name, client number for a client on the
account, responsible party owes, reporting
unit for a client on the account, last service
date for a client on the account, date hold was
entered to the system, who entered the hold
adjustment, account hold reason code,
adjustment comment.
MHS 140 &
141
PSP 143
PSP 146
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 38 of 45
47
Client Account Ledger
This report lists services, payments, and other
financial activities on a client account, for the
time period you specify. It includes a running
balance for the account, and summary totals
of the account balance and client liability for
the account. Services to the account,
including transfer balance services created
through account adjustments. Service lines
show reporting unit, procedure name, and the
cost of the service. Payments to the account
from all payer sources. Payment amounts
refunded due to cross-over (marked as
Refunds). Medicare and Medi-Cal write offs.
MHS 147
48
49
Staff Master Reports
This report lists basic information about staff.
PSP 148
Medicaid Claim Analysis
MHS 150
50
Medicare/Insurance Claim
Analysis
51
Posting Messages report
52
Clients without an Account
This report accommodates sequential billing,
which requires you to bill the primary payer
(Medicare or insurance) before billing MediCal. The Full Units, Full Time, Full Dollars
columns include data where Medi-Cal is being
billed at full rate, and there is no payment
from primary payers. The Net Units, Net
Time, and Net Dollars columns include data
where Medi-Cal is being billed at the net
amount, which is the billing rate minus the
amount paid by the primary payer. The Total
Units, Total Time, Total Dollars columns
include the Full plus Net columns, the total
amount claimed to Medi-Cal.
This report includes four reports: for Medicare
Outpatient claims, for CMHC claims, for
Outpatient Insurance claims, and for Inpatient
Insurance Claims. These four reports have the
same format, and each has three parts: Part A
is an analysis of claims by Reporting Unit and
claim procedure for the current month. Part
B includes all services from prior months that
were not previously claimed and also shows
dollar amounts and number of units billed by
reporting unit by service month/claim
procedure code. Part C is a summary of all
services billed on the claim run, organized by
service month. It displays the total dollar
amount, time units and units of service for
each service month.
This report lists the previous night’s posting
activities.
This report lists all clients whose services
have been suspended by the posting system
because they lack accounts.
53
Services without Deductible
This shows services in billing status that
cannot be processed because; a client has no
account, no liability or a service is outside
existing liability period.
MHS 158
MHS 151
PSP 153
PSP 157
County of Nevada
RFP: Nevada County Behavioral Health - EHRS
Page 39 of 45
54
Bad Address Report
This report lists all accounts with bad
addresses, by responsible party name. It does
not include system generated accounts.
PSP 160
55
Account Service Ledger
This report lists all services, bills, payments
and adjustments for all clients on an account.
It is the most complete and detailed standard
report on an account and is restricted by a date
range rather than reporting the entire account
history. Includes 5 major sections, listed and
described as; Account Information,
UMDAPS and Services, Payment
Information, Claim Information and
Adjustment Information.
MHS 161
56
Account Status Summary Report
PSP 163
57
Liability Due Report
58
Insurance company Master Lists
59
Daily Adjustments Log
60
Aged Payments in Audit
This report summarizes all the information
about an account: Responsible Party
information, all clients on the account, past
and current Liabilities completed for the
account, all episodes, services, adjustments,
insurance policies, Medi-Cal Eligibility,
claims, and payments for the account.
This report lists clients who should be
reviewed to determine their liability. It lists
clients with open episodes who have received
services in the last 90 days and whose liability
period will expire within a specified number
of days from the run date (usually 45 to 90
days) or • whose liability has expired and
been replaced by a rollover liability. Rollover
liabilities are created by the system and must
be updated with current information using the
Financial Information screen. The report
shows the client name, number, account
number, episode opening date, last service
date, date current liability information expires,
annual liability and reporting unit or billing
group, listed by reporting unit and primary
staff.
This report lists all insurance companies in the
system.
This report lists all adjustments entered into
the system the previous day. It displays
Account/Client number, Account/Client
name, effective date, adjustment amount,
Account Balance, RP Owes, type of
adjustment, adjustment comment, and staff
entering the adjustment. Adjustments are
sorted by status (Ready, Posted, Error, etc.),
and within each status, are listed
alphabetically by account or client name.
This report lists payments that were entered
some age period ago and are still in To Audit
or In Audit status. You must run a Payment
Audit Report or Payment Deposit Report for
these payments to move them to post status.
PSP 164
PSP 167
MHS 170
MHS 171
County of Nevada
61
Payment Audit Report
62
Payment Deposit Report
63
Payment Deposit Control Record
64
Insurance Policy Approval Report
65
Potential Insurance Coverage
66
Missing Social Security/CIN
Numbers
67
Legal Status Summary
68
Outpatient Utilization Control
Report
RFP: Nevada County Behavioral Health - EHRS
Page 40 of 45
This report is the first step in auditing
payments. It lists newly entered payments
and checks. It is used to verify the accuracy
of payments, and it moves payments from To
Audit status (their status on entry) to In Audit
status. The report is divided into files for
Client payments, Insurance/Medicare
payments, and Checks.
This report allows a final review of patient
and Insurance/Medicare payments before
posting. It moves the payment from In Audit
status to Post status. If there is centralized
payment entry, it produces a single report file.
If there is decentralized payment entry by
programs, it produces a report file for each
program.
MHS 172
The Payment Deposit Report. It lets you
insert and delete report parameters, such as
payment type, payment entry date and
reporting unit. Each set of report parameters
is contained in a record called a Payment
Deposit Control Record.
This report lists active insurance policies that
do not contain all information required to
submit an insurance claim. Insurance Policies
are listed if they are missing one or more of
the following: Assignment of Benefits (AOB)
on file, Release of Information (ROI) on file,
or Other Policy information.
This report lists clients who have incomes
greater than an agency-designated amount or
who are employed, but who have no current
insurance information on file.
MHS 174
This report lists all clients with no Social
Security Number in the client record. It
leaves a space for staff to fill in the client’s
SSN/CIN.
This report is a quarterly summary of clients
who are involuntary detained in the inpatient
unit and other involuntary programs. For each
Reporting Unit, it lists the total number of
clients under 72-hour hold (Minors), 72-Hour
Hold (Adults), 14-Day Hold, Additional 14Day Hold, Thirty Day Hold, and 180 Day
Certification. It also gives totals for all
Reporting Units.
This report lists clients who need a new
Utilization Control authorization. It shows all
clients whose UC Authorization is about to
expire, sorted by Program, Staff, and Client.
MHS 186
MHS 173
PSP 177
PSP 178
MHS 189
MHS 192
County of Nevada
69
Outpatient Unauthorized Services
Report
70
Client UC History Report
71
Unbilled Services Report
72
Potential Medicare Clients
73
Caseload Statistics Report
74
Accrual/Cash Collections
75
Billing Precedence Check
RFP: Nevada County Behavioral Health - EHRS
Page 41 of 45
This report lists all clients who have received
a service in the last 15 days that was not
authorized by a current Utilization Control
Authorization. It lists client, service, therapist
and cost of service, and it also includes
additional information about the client’s
episode and primary treatment person.
The report lists all Utilization Control
Authorizations for all Episodes for a Client, in
the specified Reporting Unit and time period,
and lists the services posted to each UC
Authorization.
This report shows all services that could have
been billed to Medi-Cal but were not, either
because there was not a current Utilization
Control Authorization, or because there was
no medical necessity.
This report lists clients 65 years old or older
who have open episodes and who do not have
a Medicare insurance policy entered in the
computer system.
For each staff person, this report shows the
active caseload: the number of clients served
for the period, the total units of direct and
indirect services, and the total time spent on
direct and indirect services. For each
reporting unit, this report shows the active
caseload the number of clients served for the
period, the total units of direct and indirect
services, the total time spent on direct and
indirect services, and the number of unique
clients seen during the period. • : For each
reporting unit, this report shows the active
caseload the number of clients served for the
period, the total units of direct and indirect
services, the total time spent on direct and
indirect services, and the number of unique
clients seen during the period.
This report shows collections for Reporting
Units, listed by Service Function Code. It
includes payments from Medi-Cal, Medicare,
Insurance, and Patients, reported on either
cash or accrual basis. The Cash report lists
payments on the date when they were
received. The Accrual report lists payments
on the date when the service that generated it
was performed.
Billing Precedence determines the order to bill
for services covered by more than one payer.
Each combination of Reporting
Unit/Procedure/Payer in Provider Balances
requires a matching billing precedence record.
This report lets Operations Staff find Billing
Precedence records that are missing.
MHS 194
MHS 197
MHS 198
MHS 205
MHS 206
MHS 216
PSP 245
County of Nevada
76
Account Receivables Report Client Receivables Detail
77
Staff Appointment Roster
78
Appointment Chart Pull Report
79
Payment Staging Error Report
80
Pending Claims Report
81
Physician Caseload Report
82
EPSDT Report
83
Units of Service Data Extract
RFP: Nevada County Behavioral Health - EHRS
Page 42 of 45
This report lists outstanding patient
receivables. It is very flexible. It may be used
for central or program based collections. It
may be sorted by billing group/responsible
party name or by reporting unit/therapist.
Users may request the report for: all
programs, groups of programs or a single
reporting unit, only open episodes, only
closed episodes, or open and closed episodes,
for accounts owing above a specified amount,
for accounts outstanding over a certain
number of days.
This report shows service information for
clients with appointments scheduled on the
specified date. It lists services by
appointment time, and it includes space to
record the actual service and the next
appointment. It is sorted by staff.
This report shows clients with appointments
on a specified date, listed by reporting unit. It
can be sorted by Client Number or by Client
Name
Payment Staging routine converts information
from Medi-Cal and Medicare EOB tapes into
payments written against claims. For a
payment record to be written and applied to a
claim, the EOB Claim Identification Number
and Billed Amount must match your claim
line information. If there is a mismatch, the
payment staging record cannot be applied and
is moved to error status
PSP 247
This report lists pending claims by insurance
company, and summarizes pending claims by
payer source. A pending claim is a claim that
has been produced by the posting system but
has not been sent to a carrier for
reimbursement.
This report lists all clients assigned to each
physician. In addition to client name and
number, episode opening date, last service
date, and diagnosis, it lists other reporting unit
and staff who also have open episodes for the
client.
This report displays direct service information
for EPSDT (Early and Periodic Screening,
Diagnosis and Treatment) eligible clients. It
includes only services claimed to Medi-Cal.
PSP 264
The report creates summary records on
service and cost data for direct and indirect
services. It lists the total units of service and
total charges for each combination of mode,
reporting unit, service function code,
procedure code, and month. It stores this
summary data in a comma-delimited file,
which you can import into a spreadsheet
application
PSP 354
MHS 251
MHS 252
MHS 263
PSP 280
PSP 353
County of Nevada
84
Summary DMH - Cost Report
MediCal Detail
85
Special Populations Client
Summary
86
Health Families Exact Match
Report
87
Healthy Families Partial Match
Report
88
Partial Match
89
Share of Cost
90
Exclusion of CSMP and County
Selected Aid Codes
91
Medicare and other health
Coverage Information
92
Out of County POE
93
Mental Health Group Service
Roster Report
94
Medi-Cal Duplicate Services
RFP: Nevada County Behavioral Health - EHRS
Page 43 of 45
This report is a summary description of a
client’s demographic and clinical history. It
can be placed in the chart as a face sheet, if
that is local policy. The report will satisfy the
state requirement. Work denied and/or
suspended claims. Support internal and
external audits. Evaluate provider
performance. Adjudicate fees for contract
providers.
Special Populations Client Summary Report
creates a summary of clients assigned to
Special Population Groups by client within a
special population group.
This report exact matches between the system
clients and Healthy Families eligibility and
can only be run if the previous process was
completed successfully.
This next procedure picks up the partially
matched clients with “9H” aid codes.
PSP 356
This report reads the partial-match client data.
Partial-match clients are defined as clients
who have either SSN and DOB, SSN and
Name, or Name and DOB, that matched with
an existing NCBH client.
This report shows client eligibility with Share
of Cost. This report writes to an output file so
that operations staff can identify Share of Cost
clients and take the appropriate action,
depending on state and local policy.
MHS 382
This report identifies CMSP and other clients
in the MEDS Extract File whose aid code
exists in the CMSP Table, as populated by the
county.
This procedure reports this insurance
information and allows you options on writing
pending Medicare policies into the system.
These policies would not be effective until
operations staff have reviewed them.
MHS 384
The report includes Out of County clients
based on the county codes in the MEDS tape
record. This report writes the information to
an output file.
This is a group service roster. This report can
be produced daily to show all open groups
scheduled to meet on that day.
MHS 386
This report identifies Medi-Cal duplicate
services by CDS Provider Code, HCPCS
code, Modifiers, Client Number, Service
Date, and Duration. These services have not
yet had Medi-Cal claim lines created and may
be shown in the service posting as "Duplicate
skipped".
PSP330
PSP 358
PSP 366
PSP 367
MHS383
MHS 385
PSP 395
County of Nevada
95
Medi-Cal Duplicate Services
Overridden
96
Aged Payment Report- Patient
Payments
97
AB3632 Service Report
98
SCMCII EOB Denials Report
99
Medi-Cal Eligibility Verification
Report
100 Outpatient Medicare Claim
Exception Report
101 Outpatient Insurance Exception
Report
102 Failed Service Report
103 Authorization Reports
104 DMH Cost Report
RFP: Nevada County Behavioral Health - EHRS
Page 44 of 45
This report revisits potential duplicate
services identified by Medi-Cal Duplicate
Services Report. It will automatically
insert the duplicate override code to these
services
This report lists payments that were entered
some age period ago and are still in To Audit
or In Audit status. You must run a Payment
Audit Report or Payment Deposit Report for
these payments to move them to Post status.
The clients on this report have an active
school district and non-AB3632 services. The
services listed on the report were entered on
the previous business day. To be reviewed for
accuracy.
EOB Denials received due to Short Doyle
Phase II requirements.
This report lists all of the clients that do not
have valid Medi-Cal in the system such as
excluded aid codes, SOC, other insurance,
Healthy Families, CMSP, no eligibility.
Claims for the clients listed on this report are
missing information needed for billing. The
error message indicates what specific
information is missing information.
Claims for the clients listed on this report are
missing information needed for billing. The
error message indicates what specific
information is missing information.
This report indicates any service that is in a
pending status and unable to be posted and
claimed due to incomplete data, such as
missing diagnosis, missing e-signature, a
service submitted without the proper note
attached.
Separate Reports for authorization of in-house
versus contracted providers, including fields
for name, client number, provider or RU,
authorization start date, authorization end
date, number of sessions, provider name, type
of service
Requirements as defined by the Department of
Mental Health. Template on the ITWS. Data
elements that map to Cost Report
105 Alcohol and Drug Cost Report
Requirements as defined by the Department of
Mental Health. Template on ADP website.
Data elements that map to ADP cost report
106 CSI Report
CSI reporting capabilities - access to CSI data
elements
CalOMS reporting capabilities - must have
access to CalOMS data for flexible outcome
reporting
107 CalOMS Reports
PSP331
MHS171
PSP341
County of Nevada
108 DATAR Reports
109 DCR Reports
110 Exception/Error Report
111 Scheduled Reports or Batch
Reports
112 Accounts Receivable/Aging Client
Payments
113 Accounts Receivable/Aging
Insurance
114 Accounts Receivable/Aging MediCal
115 Productivity Report
116 Suspension Report
117 No Show Report
118 Documentation Due Reports
119 Proposition 36 Report
120 Alcohol and Drug Service Detail
121
Report
Mental Health and Alcohol and
Drug Service report
122 Alcohol and Drug Detail Report
123 Authorization Reports Hospital/IMD/Residential Care
124 Alcohol and Drug Usage Report
RFP: Nevada County Behavioral Health - EHRS
Page 45 of 45
Must have standard DATAR reporting
capabilities
Must have standard MHSA DCR reporting
capabilities
Must have internal error checks--for NPI
numbers, Medi-Cal eligibility, etc…
System should be able to run scheduled
reports, or easily run batch reports
System should have Accounts Receivable
aging report for client billing showing 30
days, 60 days, etc…with amounts in each time
bucket for each client/group of clients
System should have Accounts Receivable
aging report for insurance billing, showing 30
days, 60 days, etc…with amounts in each time
bucket for each payor/group of payors
System should have Accounts Receivable
aging report for Medi-Cal claims, showing 30
days, 60 days, etc…with amounts in each time
bucket
System should have Productivity Report
capability; including pulling hours worked
from system and allowing selection of service
function codes to be included in "billable"
activities
"Suspension" report showing services that are
suspended from Medi-Cal or other billing due
to no NPI, Credentialing, no or expired
authorization, no valid diagnosis, etc…
No Show report
Report for clinicians to see what's due or
missing (treatment plans, progress notes,
etc…)
Shows Prop 36 assessments, placements,
authorizations, client name, provider name,
NPI, units of service
Provider service detail for ADP (see 117
report for field listing)
Provider detail - both MH and ADP services
on single report (see 117 report for field
listing)
Detail with client name, units, etc…(same
detail as 356 report listed above)
Track authorizations for these facilities; report
on authorizations versus actual days used
Showing number of days/hours/services for
outpatient and inpatient related to SAPT,
Prop36, and other ADP programs/funding
sources/contractors