Medical Records Check List

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					Hospital Name:      SCVHHS Behavioral Health Information System

Vendor Name:        [Enter Vendor Name Here]

Applications Bid:
       A=           [Enter Application A Here]
       B=           [Enter Application B Here]
       C=           [Enter Application C Here]
       D=           [Enter Application D Here]
       E=           [Enter Application E Here]
       F=           [Enter Application F Here]
                    Table of Contents                 Mnemonic   Notes
     Patient/Client Management
     Preadmission                                       PRE
     Registration                                       REG
     Admission, Discharge, Transfer Medical Records
     Index                                              ADT
     Enterprise Master Patient Index                    MPI
     Census Reporting                                   CEN
     Medical Records                                    MED
     Online Client Eligibility                          OCE
     Patient Accounting
     Grants Management                                  GRM
     Financial Analysis / Entitlement / PFI             PFI
     Patient Accounting                                 PAM
     Payer Contract Management                          PCM
     Cost Accounting                                    CAM
     Managed Care Operations
     Member Enrollment/Eligibility                      MEE
     Authorization/Referral Tracking                    ART
     Claims Processing/Adjudication                     CPA
     Provider Contract Management and Negotiation
     Support                                            CMN
     Provider Relations Management                      PRM

     Access Management: Call Logs / Client Contacts     ACM
     Clinical Operations

     Electronic Medical Record                          EMR
     Behavioral Health Assessment and Outcomes
     Measurement                                        BHA
     Behavioral Health Treatment Plans and Notes        BHT
     Order Entry Management                             OEM
     Clinical Decision Support                          CDS
     Resource Scheduling                                RES
     Quality Assurance - Followup                       QAF
     ePrescriptions
     Clinician Access View                              CAV
     Incident Reporting                                 INC
     Clinical Pathways / Guidelines                     CLP


     General System Functions
     Multientity                                        MEN
     Security Mechanisms and Services                   SEC
     Interface Engine                                   IEN
     Screen Builder                                     SCR
     User Report Generator                              URG
     Intranet / Extranet enabled

SCVHHS Behavioral Health
Functional Requirements - CONFIDENTIAL
April 2001
ce889d78-b37a-40aa-911d-6676ae69d824.xls                                 KSA
SCVHHS Behavioral Health
Functional Requirements - CONFIDENTIAL
April 2001
ce889d78-b37a-40aa-911d-6676ae69d824.xls   KSA
PATIENT/CLIENT MANAGEMENT
MENT
VENDOR [Enter Vendor Name Here]                                                                                    FORM A
                                                                                            FUNCTIONAL REQUIREMENTS
                                                                                              (PRE) Intake / Preadmission /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                             Preregistration
        A= [Enter Application A Here]                                        D= [Enter Application D Here]
        B= [Enter Application B Here]                                        E= [Enter Application E Here]
        C= [Enter Application C Here]                                        F= [Enter Application F Here]

ID          DESCRIPTION                                                STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
     PRE.1 Provide a quick referral data collection function which
           provides search capabilities as specified in the ADT
           section and provides a screen for
           preadmission/preregistration information including:

           a. Medical Record Number
           b. California Short Doyle Number
           c. Name
           d. Maiden name
           e. Multiple aliases
           f. Confidentiality status linked to user's security
           rights, document type, and whether record is
           available for viewing, updating, printing or is not
           available
           g. Social Security number with search/verification
           function
           h. Phone number
           i. Address/Housing information, current and history,
           as specified in item PRE.20 (housing info not
           required for quick referral)
           j. Intake worker (Table generated subset from Staff
           Master table)
           k. Program sought (Table driven from Table of
           Offered Programs)
           l. Level of care sought (automatically filled in from
           table if program sought is filled in). Integrate with
           ACM access management/gateway function.
           m. Multiple chief complaint types
           n. Multiple chief complaint descriptions
           o. Required follow-up (Table driven)
           p. Modes of contact
           q. Referral Sources (Table driven from Table of
           Offered Programs)
     PRE.2 Provide the ability to retrieve and display quick
           referral data, and collect detailed referral information
           on each patient including the following:

            a. Drivers license number
            b. Driver license state
            c. Date consent given to treatment
            d. Person giving consent to treatment
            e. Citizenship
            f. Primary language (Table driven)
            g. Preferred Treatment language (Table driven)

            h. Financial Situation (Table driven with optional text)
            i. Occupation (Table driven with optional text)
            k. Description of alcohol or drug user.

            l. Recent symptoms (Table driven with optional text)
            n. Current alcohol or drug use (Y/N)
            o. Description of alchol or drug use
VENDOR [Enter Vendor Name Here]                                                                                  FORM A
                                                                                          FUNCTIONAL REQUIREMENTS
                                                                                            (PRE) Intake / Preadmission /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                           Preregistration
        A= [Enter Application A Here]                                      D= [Enter Application D Here]
        B= [Enter Application B Here]                                      E= [Enter Application E Here]
        C= [Enter Application C Here]                                      F= [Enter Application F Here]

ID          DESCRIPTION                                              STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            p. Suicidal ideations
            q. Description of suicidal ideations
            r. Aggressive ideations
            s. Description of aggressive ideations
            t. Employment information, current and history, as
            specified in item PRE.17
            u. Academic information, current and past, as
            specified in item PRE.21
            v. Religion (Table driven)
            w. Ethnicity (Table driven)
            x. Current Income

            y. Number of persons supported by current income
            aa. Family History of Mental Illness (Table driven for
            each family member)
            bb. Other out of home placements
            cc. Legal history as specified in item PRE.18
            dd. Marital status
            ee. Marital history
            ff. Medical conditions, current and past, as specified
            in item PRE.23
            gg. Military service history as specified in item
            PRE.19
            hh. Associated/Related parties in household as
            specified in item PRE.12
            ii. Consent to treatment
            jj. Date/time of consent
            kk. Person giving treatment consent

           ll. Related professionals as specified in item PRE.15
           mm. Insurance information
           nn. Treatment authorization information/Number
           oo. Medical clearance/necessity screening
           pp. Person providing treatment authorization
           qq. Treatment authorization duration
           rr. Location of intake (table driven)
           ss. Date and time of intake
           tt. Intake staff member (table driven from staff
           master)
           Upon entering new detailed preadmission data,
           retrieve from system the most recent information,
           either from the prior preadmission record or from the
           prior treatment episode -- for fields designated by
     PRE.3 Provider as "carry over" items.
           All preadmission/referral data elements should be
           available for addition or update upon registration as
     PRE.4 part of routine registration screens.
           All appropriate preadmission/referral data elements
           should be available for display, addition, or update at
     PRE.5 any time.
VENDOR [Enter Vendor Name Here]                                                                                    FORM A
                                                                                            FUNCTIONAL REQUIREMENTS
                                                                                              (PRE) Intake / Preadmission /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                             Preregistration
         A= [Enter Application A Here]                                       D= [Enter Application D Here]
         B= [Enter Application B Here]                                       E= [Enter Application E Here]
         C= [Enter Application C Here]                                       F= [Enter Application F Here]

ID            DESCRIPTION                                              STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            Provide ability for authorized users to designate
            which preadmission/ referral data elements transfer
            to subsequent registration/admission data elements
      PRE.6 on a program by program basis.

              For each data element collected in
              preregistration/preadmission screen allow indication
              of table driven source of information with default
      PRE.7   determined on program by program basis.
              System maintains original referral/preregistration
              data that are not altered by updates to other areas of
      PRE.8   patient record post registration
              Provide ability to capture information on special
              needs of patient including limits on mobility, vision,
      PRE.9   hearing, and language translation services.
              Upon new referral, system retrieves most recently
              updated data from system according to
     PRE.10   specifications of authorized users.
              System displays information on insurance
              requirements for precertification and authorization of
     PRE.11   services. (Table driven by Insurance Master)

     PRE.12 Allow system to maintain and display information on
            associated related parties including information on:
            a. Name of person
            b. In household (Y/N)
            c. Relationship to patient (Table driven)

              d. Quality of relationship with patient (Table driven)
              e. Address (if not in household)
              f. Telephone (if not in household)
              g. Mental health history in accordance with item
              PRE.16
              h. Guardianship status
              i. Custodial status
              j. Emergency contacts
              k. Parole Officer
              l. Length of time in household (if in household)
              m. Occupation
              System maintains file of external treatment
PRE.13        organizations including:
              a. Agency name
              b. Agency address
              c. Contact name
              d. Telephone number
              e. Fax number
              f. Multiple services offered
              g. Multiple areas of expertise
              h. Multiple populations served
              i. Multiple payments accepted
VENDOR [Enter Vendor Name Here]                                                                                   FORM A
                                                                                           FUNCTIONAL REQUIREMENTS
                                                                                             (PRE) Intake / Preadmission /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                            Preregistration
         A= [Enter Application A Here]                                      D= [Enter Application D Here]
         B= [Enter Application B Here]                                      E= [Enter Application E Here]
         C= [Enter Application C Here]                                      F= [Enter Application F Here]

ID          DESCRIPTION                                               STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            Associated with each service offered under part "f" of
            PRE.13 (for organizations offering multiple services)
PRE.14      allow collection of:
            a. Program type
            b. Program name (default to program type)
            c. Agency address (default to agency address)
            d. Contact name (default to agency contact)
            e. Telephone number (default to agency phone)
            f. Fax number (default to agency fax)
            g. Multiple populations served
            h. Multiple payments accepted
            Capture and maintain data on related professionals
PRE.15      including information on:
            a. Name of professional
            b. Type of professional (Table driven)
            c. Address
            d. Telephone number
            e. Date of last treatment with professional
            f. Reason for treatment
            Provide the ability to retrieve information on previous
PRE.16      behavioral health treatments including:
            a. Episode begin date
            b. Episode End date.
            c. Treatment agency
            d. Level of care
            e. Program
            f. Unit
            g. DSM Admission diagnoses
            h. DSM Discharge diagnoses
            i. Primary physician
            j. Primary physician telephone number
            k. Primary clinician
            l. Primary clinician telephone number
            m. Response / final disposition to treatment (Table
            driven)
            n. Substance abuse episode (Y/N)
            Provide the ability to collect and maintain
PRE.17      employment data including information on:
            a. Employer name
            b. Employer address
            c. Job title or type
            d. Start and end dates
            e. Reason for leaving job
            f. Income
            g. Performance information
            h. Job satisfaction (Table driven)
            i. Quality of relationship with co-workers
            j. Quality of relationship with supervisors

            k. Occupational level (based on Hollingshead scale)
            l. Current employment status
            m. Detailed employment history
VENDOR [Enter Vendor Name Here]                                                                                 FORM A
                                                                                         FUNCTIONAL REQUIREMENTS
                                                                                           (PRE) Intake / Preadmission /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                          Preregistration
         A= [Enter Application A Here]                                    D= [Enter Application D Here]
         B= [Enter Application B Here]                                    E= [Enter Application E Here]
         C= [Enter Application C Here]                                    F= [Enter Application F Here]

ID          DESCRIPTION                                             STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID

PRE.18      Capture and maintain data on legal history including:
            a. Legal problems/ charges/arrests
            b. Convictions
            c. Months incarcerated
            d. Parole data
            e. Probation data
            f. Outcome of legal problems/charges
            g. Mandated mental health treatments
            h. Comments (unlimited free text)
            Capture and retain data on military service history
PRE.19      including:
            a. Branch of service
            b. Service dates
            c. Reason for discharge
            d. Veteran status
            Provide ability to collect and maintain housing data
PRE.20      including information on:
            a. Current home address including county

            b. Travel distance to provider determined by zip code
            c. Housing type (Table driven)
            d. Catchment area determined by zip code
            e. Patient satisfaction with housing (Table driven)
            f. Detailed address history with dates
            g. OK to contact home (Table driven)
            h. Number of people in household
            Capture and retain data on academic history
PRE.21      including information on:
            a. Last grade completed
            b. Schools attended and dates
            c. Teachers names at each school (for children &
            adolescents)
            d. Teachers telephone number (for children &
            adolescents)
            e. Guidance counselor name at each school (for
            children & adolescents)
            f. Guidance counselor telephone (for children &
            adolescents)
            g. Special education status
            h. Special problems
            i. Attitude towards school
            j. Parental attitude towards school
            k. Self-assessment of academic functioning
            l. Schools assessment of academic functioning
            m. Extracurricular activities
            n. Quality of relationships with other students
            o. Quality of relationships with teachers
            p. Comments (unlimited free text)
            Capture and retain data on current marital status and
PRE.22      history.
VENDOR [Enter Vendor Name Here]                                                                                   FORM A
                                                                                           FUNCTIONAL REQUIREMENTS
                                                                                             (PRE) Intake / Preadmission /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                            Preregistration
         A= [Enter Application A Here]                                      D= [Enter Application D Here]
         B= [Enter Application B Here]                                      E= [Enter Application E Here]
         C= [Enter Application C Here]                                      F= [Enter Application F Here]

ID          DESCRIPTION                                               STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            Provide the capability to collect medical history data
PRE.23      including:
            a. Current illnesses
            b. Recent illness
            c. Long term illness
            d. Medical treatments received last two months
            e. Name of treating physicians
            f. Telephone number of treating physicians
            g. Other medical problems
            h. Comments (unlimited free text).
            i. Allergies
            If mental health history is collected on family member
            these data should be available at other points in
            system where History of Mental Illness in Family is
PRE.24      collected
            All required fields have an online dictionary for ready
PRE.26      referral and look up
            Provides the ability to enter all registration,
            assignment, and service information for clients who
            are expected to be treated only one time at the time
            of intake. For example, intake and registration
            information is collected at the call center and is made
            available by all the service programs of the SCVHHS
PRE.27      Systems of Care
VENDOR [Enter Vendor Name Here]
                                                                                        FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
  A=       [Enter Application A Here]                                  D= [Enter Application D Here]
  B=       [Enter Application B Here]                                  E= [Enter Application E Here]
  C=       [Enter Application C Here]                                  F= [Enter Application F Here]

  ID       DESREGIPTION                                          STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           PATIENT REGISTRATION
REG    1   Accommodate registration for a minimum of ten
           service entities. Entities may be user-defined
           according to the following criteria:
           a. Site
           b. Department
           c. Section
           d. Physician
           e. Program
           f. Provider
REG    2   Capture all pertinent data required to complete all
           federal, California state, and other third party
           claim forms and reports.
REG    3   Automatically assign medical record/Short-Doyle
           number for patients who have never been seen at
           the SCVHHS Systems of Care before and those
           who do not have or do not know their social
           security number.
REG    4   Automatically assign new entity-specific patient
           accounting number for all patients upon each new
           registration/episode.
REG    5   Register outpatients in a continuing status and
           retain a patient accounting number for a user-
           defined period of time.
REG    6   Provide function codes that identify patients as
           one or more of the following types:
           a. Clinic patient
           b. Inpatient
           b. Community physician practice patient
           b. Specific program patient
REG    7   User may retrieve online patient files by name,
           account number, medical record number/Short-
           Doyle, preregistration number, social security
           number, Short Doyle number, or insurance ID
           number.
REG    8   Provide online access to summary patient index
           by patient name or number. Index provides
           selected demographics and date and type of last
           visit.
REG    9   Access to patient index by patient name is via
           Soundex capability.
REG 10     User may enter clinic/department/practice-specific
           source data as defined by the hospital or service
           sites.
  ID     DESREGIPTION                                           STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
REG 11 System prevents display of subsequent
       registration screens until all mandatory data has
       been entered or a suitable exception code has
       been entered. Users with appropriate security
       clearance have override capability.
REG 12 System prevents users from moving to the next
       screen if critical error exists on the current screen.

REG 13 Demographic data is available online for recurring
       patients without need for re-registration.

REG 14 Users may search for a patient or patient
       information across all entities through one inquiry.

REG 15 Demographic and insurance information can be
       shared by all entities. Update capability can be
       limited to individual entities when necessary or
       user may update all entities simultaneously.
REG 16 Accommodate a minimum 12 digit patient account
       number exclusive of a check digit.
REG 17 Accommodate a minimum eight digit medical
       record number exclusive of a check digit.
REG 18 Accommodate online entry of free text data
       against given services or selected patient files.
       Multiple data entry of not less than 400 characters
       for each text segment.
REG 19 Provide online tickler file for automatic clerical
       follow-up with specific patients and services.
REG 20 Provide online communication with ancillary
       services, programs, and providers to request and
       confirm appointments for services.
REG 21 Print registration record in a pre-formatted,
       multipart form, as specified by user.
REG 22 Maintain entity-specific logs of all encounters,
       including date, time, mode of transportation,
       patient disposition, final diagnosis, physician
       name, and free text comments. Display or print
       logs at user's option.
REG 23 Allow automatic transfer of relevant outpatient
       registration data to inpatient admitting system.
REG 24 Provide short registration screens for all
       outpatients.
REG 25 Accommodate family registration.
REG 26 Provide automatic identification of special classes
       of patients (e.g., VIPs or employees) who warrant
       special consideration as defined by the user, with
       a flag or code on relevant inquiries and reports.

REG 27 Demographic data (as defined by the Mental
       Health Department and DADS) may be retained
       online for an indefinite period of time.
REG 28 Data may be updated online as required.
REG 29 Generate plates and labels for all patients.
  ID     DESREGIPTION                                         STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
REG 30 User may indicate deposit required, deposit paid,
       balance due information, and user-defined credit
       status of all patients at registration.

REG 31 Known patient may be entered into system on pre-
       registration basis with subsequent update.
REG 32 Automatically purge no show pre-registration
       patients after "X" number of days from the
       expected admit date (where "X" is Hospital-
       defined) or appointment date (where "X" is
       MHD/DADS defined). Print report of all patients
       purged in this manner. Allow user to override
       purge function.
REG 33 User may define which data fields require
       episodic completion and which are carried in
       historic patient field. All episodic data fields are
       flagged for update or completion at each patient
       visit.
REG 34 Automatically generate age based on birth date
       and default birth date based on age.
REG 35 Record patient consent of release of medical
       record information and assignment of benefits.
REG 36 Edit Medicare numbers based on HCFA HIM-10
       manual criteria and MediCal numbers based on
       California state criteria.
REG 37 Echo all pertinent demographic information to
       appropriate insurance fields (e.g., patient name,
       social security number, etc.).
REG 38 User may cancel registrations and designate a
       reason for cancellation.
REG 39 User may search for patient under "Also Known
       As" designations.
REG 40 Assignment of a pay source based on a pay
       source table that is maintained separately.
REG 41 Calculation of amount owed based on a sliding
       scale calculation. Sliding scale calculation to be
       defined by MHD/DADS.
REG 42 Calculation of a maximum ability to pay based on
       user defined criteria (MHD/DADS).
REG 43 Functionality to minimize the occurrence of
       duplicate clients. For example, system will not
       allow a second client to be registered with the
       same social security number, etc.
REG 44 All required fields have an online dictionary for
       ready referral and look up.
REG 45 Provides the ability to customize all online
       registration screens including flow and data
       captured.
                            FORM A
           FUNCTIONAL REQUIREMENTS
                           (REG) Registration
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
M, W=WON'T BID
           COMMENTS
M, W=WON'T BID
           COMMENTS
M, W=WON'T BID
VENDOR    [Enter Vendor Name Here]
                                                                                FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                        (ADT) Admission, Discharge, Transfer

     A=   [Enter Application A Here]                               D= [Enter Application D Here]
     B=   [Enter Application B Here]                               E= [Enter Application E Here]
     C=   [Enter Application C Here]                               F= [Enter Application F Here]

ID        DESCRIPTION                                        STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          ADMITTING/ REGISTRATION
 ADT 1
          Admission screen should allow user to update
          any preadmission referral data (mentioned
          above) that was entered, or initially add such
          data if there was no preadmission referral.
 ADT 2    Allow authorized users to assign Treatment
          Team members with as much detail as is
          known at the time.
 ADT 3    Admission screen should include:
          a. Indication of medical clearance.
          b. Source of admission
          c. Legal status and date of legal status.
          d. Table driven entry for primary financial
          worker.
 ADT 4
          System provides all admitted patients with a
          unique account number for each episode, by
          program, which can encompass multiple visits
          over several years, and multiple service types
          within program, and attaches it to a unique
          medical record number/Short-Doyle number.
 ADT 5    For programs with automatic "preadmission
          visits", system accepts date of first
          preadmission visit and automatically assigns
          admission date after user-defined, program
          based number of days.
 ADT 6
          For program utilizing automatic "preadmission
          visits", all ticklers based upon admission date
          are triggered once patient has had required
          number of preadmission visits and admission
          date has been automatically assigned by
          system.
 ADT 7    System maintains transfer history for transfers
          between units, services, or levels of care,
          along with reasons for transfer.
 ADT 8
          When system displays list of episodes, this list
          includes transfer data within episodes.
 ADT 9
          Upon discharge, allow user to indicate
          discharge status and discharge to location .
ID        DESCRIPTION                                       STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 ADT 10   Allow reversal by authorized user of an
          admission, discharge, or transfer with
          appropriate automatic adjustments to
          statistics and other related areas within
          system.
 ADT 11
          Upon discharge, system can print or display
          payment and fee schedule information.
 ADT 12   Upon discharge allow user to display and
          collect the following data:
          a. Mental status/level (Table driven)
          b. Condition at last visit (Table driven)
          c. Disposition of case (Table driven)
          d. Discharge DSM diagnoses in accordance
          with items in "Diagnostic Assessment" -
          ADT.41
          e. Account balance
          f. Discharge Plan
          g. Date of discharge
          h. Time of discharge
 ADT 13
          If any data (from above item) had previously
          been collected during episode, it should be
          retrieved when discharge screen is activated.
 ADT 14   System allows authorized users to make
          discharged patients inactive
 ADT 15   System allows authorized users to archive
          and retrieve inactive patients
 ADT 16   System allows development and entry of an
          After Care Plan.
 ADT 17   System allows on going review and update of
          a client's After Care Plan.
 ADT 18   Automatic notification that an After Care Plan
          is due or past due for a client.
 ADT 19   Automatic notification that an After Care Plan
          review is due or past due for a client.
 ADT 20   List of all clients currently on an After Care
          Plan and their status.
          PRIMARY NURSE/ THERAPIST/ PROVIDER
          SUPPORT
 ADT 21   Allow user to enter the name of a Primary
          clinician and two Associates, onto the
          Admission screen at the point of admission or
          at a later time or date.
 ADT 22   Allow user to change the Primary clinician
          designation throughout the patient stay.
 ADT 23   Print the name of the Primary clinician on the
          admitting facesheet.
 ADT 24   When a previously discharged inpatient is re-
          admitted, automatically list the name of the
          Primary clinician of record upon discharge
          during that previous stay, and patient location
          at the time of discharge.
                         FORM A
        FUNCTIONAL REQUIREMENTS

DT) Admission, Discharge, Transfer

nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
OM, W=WON'T BID
           COMMENTS
OM, W=WON'T BID
VENDOR     [Enter Vendor Name Here]
                                                                                     FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                               (MPI) Enterprise Master Patient Index

   A=      [Enter Application A Here]                                  D= [Enter Application D Here]
   B=      [Enter Application B Here]                                  E= [Enter Application E Here]
   C=      [Enter Application C Here]                                  F= [Enter Application F Here]

   ID      DESCRIPTION                                           STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 MPI    1 Ability to assign a unique lifetime identifier to a
          client who is enrolled or seeking services at any
          point within the SCVHHS MHD/DADS healthcare
          delivery network.
 MPI    2 Ability to consolidate member/patient
          demographic information from a number of
          different facilities which are part of an enterprise
          or healthcare delivery network into a single MMPI
          for clients.
 MPI    3 Ability to consolidate member/patient guarantor
          information from a number of different facilities
          which are part of an enterprise or healthcare
          delivery network into a single MMPI.

 MPI     4 Recognizes need for retaining multiple guarantors
           per patient.
 MPI     5 Ability to tie together members/patients and
           guarantors via the MMPI regardless of the
           facility/provider they visit or department.
 MPI     6 Ability to maintain the EMPI identifier
           independently of medical record assignments at
           individual facilities.
 MPI     7 Ability to manually assign user-defined IDs (e.g.,
           medical record number, account numbers) which
           are facility-specific.
 MPI     8 Ability to automatically generate user-defined IDs
           (e.g., medical record number) which are facility-
           specific.
 MPI     9 User-defined format for MPI identifier, including
           prefixes, suffixes, provider number, facility code,
           or other facility identifier, as needed.
 MPI    10 The MPI supports access from all entities in the
           Santa Clara system.
 MPI    11 The MPI supports cross-institutional processing
           for hospital, physician, and clinic entities.

 MPI    12 Ability to specify unlimited universal versus
           encounter-specific data within the MPI.
 MPI    13 Ability to restrict access to individual
           encounter/visit data to authorized users only, at
           the facility level.
MPI   14 Ability to restrict access to functions based on:

           a. Site
           b. Program
           c. Institution
           d. Entity
MPI   15   Ability to copy forward selected MPI data into new
           client registration screens to facilitate registrations
           at individual facilities.
MPI   16   Availability of tools/utilities to assist in the
           recognition of multiple MPI numbers on a single
           client based on user-defined algorithms and
           criteria.
MPI   17   Ability to combine/merge multiple MPI numbers
           on the same member/patient, restricted to
           authorized users.
MPI   18   Ability to cross-reference multiple MPI numbers
           on the same member/patient, restricted to
           authorized users.
MPI   19   Ability to support consolidated and discrete
           management client demographic data, including
           the ability to standardize data from disparate
           sources for centralized corporate reporting.

MPI   20 Ability to support consolidated and discrete
         management reporting/analysis of guarantor data,
         including the ability to standardize data from
         disparate sources for centralized corporate
         reporting.
MPI   21 Ability to search for clients based on
         member/patient name. Must also be able to be
         tracked by multiple aliases:
         a. Full name (Last, First)
         b. Partial
         c. Soundex
         d. Ability to perform client searches based on
         Soundex name and other qualifiers/criteria such
         as:
         e. Date of birth
         f. Sex
         g. Mother‟s maiden name
         h. Other (please specify)
MPI   22 Ability to search for member/patients based on
         user-defined common selection criteria such as:

           a. Name
           b. Age
           c. Sex
           d. Social security number
           e. Other
           f. Ability to limit searches based upon
           g. Site
         h. Program
         I. Institution
         j. Entity
MPI   23 Ability to support 2-way electronic interfaces to
         multiple foreign registration systems and financial
         systems to identify established clients or create
         registration records for new clients or revise
         existing registration/financial information.

MPI   24 Ability to accept inquiries/solicits and updates
         through electronic interfaces.
MPI   25 Ability to add unlimited user-defined fields to the
         MPI.
MPI   26 Includes an explicit 'Deceased' indicator that
         contains the following:
         a. Yes / No 'Deceased' indicator
         b. Date of expiration
         c. Comments section for explanation / reason
                         FORM A
        FUNCTIONAL REQUIREMENTS

  (MPI) Enterprise Master Patient Index

nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
W=WON'T BID
VENDOR [Enter Vendor Name Here]


APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                                (CEN) Census Reporting

     A=   [Enter Application A Here]                                  D= [Enter Application D Here]
     B=   [Enter Application B Here]                                  E= [Enter Application E Here]
     C=   [Enter Application C Here]                                  F= [Enter Application F Here]

ID        DESCRIPTION                                           STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          CENSUS REPORTING
CEN 1     Print or display (at user's option) census screens
          for bed reconciliation listing for each residential
          care locations (including the hospital):

          a. All patients by bed
          b. Number of admissions
          c. Number of discharges
          d. Number and location of empty beds
          e. Number of transfers into, out of, and within
          each residential care location.
CEN 2     Print census summary reports by:
          a. Residential care location
          b. Service
          c. Physician/Provider
          d. Total facility
          e. Program
          f. Payer/Payer Code
CEN 3     Print reports of pending, actual, and cancelled
          admissions; pending and actual transfers, and
          pending and actual discharges including:

          a. Patient name
          b. Medical record number
          c. Patient care unit
          d. Service
          e. Physician/Provider
          f. Residential care location (to and from)
          g. Financial class
          h. Discharge disposition
          I. Bed number
          j. Program
CEN 4     Calculate occupancy rate (not including overflow
          and hall beds unless they are filled).
CEN 5     Maintain register on a daily, monthly, and yearly
          basis of:
          a. Admissions
          b. Discharges
          c. Transfers
          d. Preadmissions
          e. Deaths
          f. Outpatient encounters
          g. Emergency room encounters
          h. Private ambulatory encounters
ID       DESCRIPTION                                       STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
CEN 6   Print or display (at user's option) a patient
        transfer audit trail accessible by provider and
        location, medical record number, which displays
        patients' activities as they are admitted and
        transferred to another facility, service or
        program.
CEN 7   Print report of patients, with the religion and
        church of each patient, sorted by patient care
        unit.
CEN 8   Print list of patients admitted on a given day
        including:
        a. Name
        b. Address
        c. Room number/Location
        d. Program
        e. Religion code
CEN 9   System is capable of interfacing with hospital's
        ADT (SMS) system to get the above required
        information.
                              FORM A
             FUNCTIONAL REQUIREMENTS

                    (CEN) Census Reporting

nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
M, W=WON'T BID
           COMMENTS
M, W=WON'T BID
VENDOR [Enter Vendor Name Here]


APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
  A=     [Enter Application A Here]                                       D= [Enter Application D Here]
  B=     [Enter Application B Here]                                       E= [Enter Application E Here]
  C=     [Enter Application C Here]                                       F= [Enter Application F Here]

   ID      DESCRIPTION                                              STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           MEDICAL RECORDS MASTER CLIENT INDEX
           Maintain client demographic and visit/admission
           information online, for timeframe specified for all
 MED     1 client types.

           Provide for automatic and manual assignment of
 MED     2 medical record number and bar code for new clients.
           Display the tie breaker and list clients when same
           names are on file, such that the correct client can be
           determined by social security number, medical
           record number, Short Doyle number, date of birth,
           mother's maiden name and/or spouse name. If
           spelling of name is uncertain, list all names that
 MED     3 sound alike.
           Provide "Phonetic" search for names that sound
 MED     4 alike.
           Automatically retrieve existing medical record
 MED     5 numbers for repeat clients.
           Allow only authorized users to make
 MED     6 deletions/changes in client information files.
           Print revised client information following
 MED     7 deletions/changes.
           Allow correction of erroneously assigned medical
           record numbers and names, with appropriate audit
 MED     8 reports.
           Automatically transfer all data from incorrect or
           duplicate medical record numbers to correct
 MED     9 number/name, including visit history.
           Search for client by name, aliases, maiden name,
           medical record number, Short Doyle number and
 MED    10 retrieve activity information.
           Automatically cross-index all corrected names,
           medical record numbers, Short Doyle numbers,
 MED    11 aliases and maiden names.

        Maintain, display, and print clinic, provider, and other
        treatment facilitiy logs, including Registration Logs,
 MED 12 for multiple sites and client types.
           MEDICAL RECORD CHART COMPLETION

        Provide identification of incomplete charts by client
        name, medical record number, responsible
        physicians/providers, and tasks for completion,
 MED 13 without rekeying of client identification information.

        Allow assignment of record deficiencies using
 MED 14 predefined MHD/DADS criteria for completion tasks.
  ID      DESCRIPTION                                              STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          Provide cross-reference by physician/provider name
          and number for assignment of chart completion
 MED 15   tasks.
          Produce reference sheet for each record displaying
          physician/provider assignments and documentation
 MED 16   deficiencies.
          Provide online, real time file update to reflect chart
 MED 17   completion activity including:
          a. Task completion
          b. Updates of physician/provider assignments
          c. Assignments of new tasks
          d. Assignment of "grace days" for records
          unavailable for completion
          Provide status of individual records by client medical
          record number or Short Doyle number or client
 MED 18   name online and via printed report.

          Produce physician/provider notices with pre-defined
          format and content, of incomplete records by client
 MED 19   name, record age, and type of deficiency.
          Generate suspension notices for delinquent records
          in accordance with agency record completion
 MED 20   policies.
          Track cumulative suspensions (and other actions)
          per physician/provider over specified time periods
 MED 21   and provide quarterly report.
          Generate administrative reports of totals of
          incomplete charts by physician/provider, by
 MED 22   service/program.
          Generate status reports of incomplete records,
 MED 23   including:
          a. Total incomplete records
          b. Total delinquent records

          c. Total number of delinquent physicians/providers
          d. Total delinquent records by type of deficiency
          MEDICAL RECORD CHART LOCATION
          Provide fields and reports to monitor, control, and
          track chart movement between a minimum of nine
          clinic locations and transfers between offices and
 MED 24   medical record processing stations.
          Accept, store, display, and report a "home site" for
          each record which indicates that record's primary
 MED 25   clinic residence.
          Provide online entry of current and previous chart
          storage locations, and physician office record
          location, including separate storage areas for
          multiple volume records; maintain audit trails of
 MED 26   record transfers from one site to another.
 MED 27   Enter, modify, and delete record requests.
          Request charts online from system terminals, or
          interfaced systems and personal computers across
 MED 28   all locations in the delivery system.
          Print charge-out slips for individual records,
 MED 29   including:
   ID      DESCRIPTION                                            STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
        a. Physician/provider name
        b. Medical record number
        c. Short Doyle number
        d. Location needed
        Sign charts out to one location by batch entry or
 MED 30 single record entry.
        Print lists of records for microfilm purge or transfer
        to remote storage using MHD/DADS-defined criteria
        (e.g., all records with encounter dates in "X" year) in
 MED 31 terminal digit order.
        Track records stored on microfilm (roll and fiche), as
 MED 32 well as hard copy records and offsite storage.

        Search for record location using client name or
 MED 33 medical record number and client account number.

        Print or display, at user's option, listings of records
 MED 34 by designated locations/physician/provider offices.
        Print or display, at user's option, listings of overdue
        records by responsible location/physician/provider
 MED 35 office.
 MED 36 Print bar code labels for record identification.

        Use bar code readers to log out and log in records
 MED 37 and for taking inventory of records on hand.
        Generate overdue chart notices using MHD/DADS-
 MED 38 defined criteria.
           MEDICAL RECORDS/ DISCHARGE RECORD
           PROCESSING
        Print list of all discharged clients whose charts have
        and have not been received record control purposes
 MED 39 at end of day.
        Print report of system calculated days between
        present date and client appointment date for all
        records not received in following client appointment
        date. Date is reported by client name and payor
 MED 40 class.
        Print labels for chart folders (including client name,
        medical record number), as well as a user-defined
 MED 41 number of extra labels.
           MEDICAL RECORD ABSTRACTING
        For all data entered manually, provide online
        validation of registration and demographic
 MED 42 information.

        Accommodate multiple locations, multiple services,
 MED 43 and multiple program data collection, including:
        a. Inpatient
        b. Residential care
        c. Clinic appointments
        d. Emergency Care Unit
        Allow each abstract record to accommodate ten
 MED 44 diagnoses, ten procedures, and ten consultants.
   ID      DESCRIPTION                                             STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
        Allow user to page forward and backward through all
 MED 45 abstract screens.

           Allow authorized users to update clinical information
           after discharge and update information previously
 MED 46    entered for a user-specified period of time.
           Provide diagnostic and procedural information
           coding according to DSM, ICD-9-CM and CPT-4
 MED 47    classification systems, including edit checks.
           Provide all DSM, CPT-4 and ICD-9-CM codes, short
           descriptions, and long descriptions for user review
 MED 48    online.
           Maintain online user-defined number of editions of
           same coding system to be used, dependent on
 MED 49    financial payor and/or date of service.
           Cross walks between DSM codes, ICD-9 codes and
 MED 50    CPT-4 codes.
           MEDICAL RECORD CORRESPONDENCE

        Maintain administrative files that catalog requests
 MED 51 and release of medical record information.
        Maintain administrative files that catalog receipt of
 MED 52 and information released via subpoena.
        Maintain administrative files that catalog medical
        record information requested and released in cases
 MED 53 involving Agency litigation.
        Automatically track medical record correspondence
 MED 54 billing and payment information.
                              FORM A
             FUNCTIONAL REQUIREMENTS
                     (MED) Medical Records
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
COMMENTS
COMMENTS
COMMENTS
VENDOR     [Enter Vendor Name Here]
                                                                                    FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES

  A=       [Enter Application A Here]                                D= [Enter Application D Here]
  B=       [Enter Application B Here]                                E= [Enter Application E Here]
  C=       [Enter Application C Here]                                F= [Enter Application F Here]

  ID       DESCRIPTION                                         STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 OCE     1 Provide online verification of eligibility using
           employer group, provider, employer group ID,
           and employer name.
 OCE     2 Enable user to enter free text annotation on
           eligibility screen(s).
 OCE     3 Provide eligibility information online including
           eligibility dates, premium rates, and contract
           information for eligibility periods.

 OCE     4 Provide online access to the following payer
           organizations to verify eligibility, coverage,
           and report utilization as required per contract.

           a. Medicare
           b. California MediCal (MEDS)
           c. Siemens HDX (Health Data eXchange)
           third-party eligibility clearinghouse
           d. Other Third-party eligibility clearinghouse
           (Please specify)
 OCE     5 Online eligibility requests utilize the ANSI X12
           270 data content and message standard.

 OCE     6 Provide the ability to send a eligibility request
           to SCVHHS specific payer organizations
           using the online eligibility request/response
           functionality of the bid application.

 OCE    7 Retain historic eligibility data files on clients
          including intermittent changes.
 OCE    8 System provides alternative name search for
          a Client
 OCE    9 Provide access to eligibility information by:
          a. Employer group
          b. Payer
          d. Union
 OCE   10 System provides online notification of cut-off
          dates, expiration dates, and COBRA with
          regard to eligibility.
 OCE   11 Generate disenrollment report.
OCE   12 Provide capability to load bulk
         membership/eligibility data files provided by
         SCVHHS payers.
OCE   13 Provide 'out-of-box' interface definition for the
         California MEDS eligibility data file.
OCE   14 Generate reports based on type of coverage.
                                 FORM A
           FUNCTIONAL REQUIREMENTS
                       (OCE) Online Client
                                Eligibility
nter Application D Here]
nter Application E Here]
nter Application F Here]

            COMMENTS
OM, W=WON'T BID
PATIENT ACCOUNTING
VENDOR     [Enter Vendor Name Here]
                                                                                 FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
  A=       [Enter Application A Here]                             D= [Enter Application D Here]
  B=       [Enter Application B Here]                             E= [Enter Application E Here]
  C=       [Enter Application C Here]                             F= [Enter Application F Here]

  ID       DESCRIPTION                                      STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
GRM      1 Display and print on demand a SCVHHS
           internal applicant profile for unlimited
           number of applicants including:
           a. Applicant name
           b. Title
           c. Department
           d. Coded grant subject classification
           e. Requested funds
GRM      2 Display and print on demand a granting
           institution profile for an unlimited number of
           granting institutions including:
           a. Institution name
           b. Address
           c. Telephone number
           d. Contacts
           e. Coded grant subject classification
           f. Current grants available
GRM      3 Display and print SCVHHS grant profiles
           for each grant including:
           a. Granting institution
           b. Start date
           c. Duration/end date
           d. Required reporting dates
           e. Original budget
           f. Revised budget
           g. Recipient of grant
           h. Free text comments
GRM      4 Maintain an online grant tracking profile
           including:
           a. Granting institution
           b. Date of application
           c. Applicant
           d. Current status
           e. Follow-up dates
           f. Date of approval or rejection
           g. Reason for granting institution rejection

GRM      5 Cross match investigators and granting
           institutions based on coded grant subject
           classification.
  ID      DESCRIPTION                                      STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
GRM     6 Print a statistical report indicating for each
          granting institution the number of grant
          applications submitted, the number of
          grants awarded, and percent of total
          MHD/DADS awards (both number and
          dollar denominators) on a year-to-date
          basis. This report should be available for a
          user-defined number of years' worth of
          data.
GRM     7 Print a statistical report for each applicant
          indicating the number of grant applications
          submitted, the number of grants awarded
          and the awarding institutions, and the
          percent of total MHD/DADS awards (both
          number and dollar denominators). This
          report should be available for a user-
          defined number of years' worth of data.

GRM     8 Print an open proposal report listing all
          outstanding grant requests, dollar amount,
          date of application, and expected award
          date.
GRM     9 Accommodate an unlimited number of
          individual grant profiles and treat each
          grant as a separate account for fund
          tracking.
GRM    10 Accommodate an unlimited number of
          subaccounts for each grant.
GRM    11 Budget expenses (including salary and
          fringe) across multiple grant accounts or
          grant subaccounts.
GRM    12 Budget indirect expenses across grant
          accounts.
GRM    13 Print a subaccount listing of all
          expenditures in a user-defined time period
          by grant. At the user's option, restrict the
          report to a single grant.
GRM    14 Accommodate user-defined special grant
          types including discretionary funds, start-up
          funds, and special purpose funds.

GRM    15 Support sponsor billing for grant funds that
          are not provided directly to MHD/DADS, but
          must be requested as needed.

GRM    16 Support interest allocation across grant
          accounts based on a user-defined
          methodology.
GRM    17 Support user-defined codes for grant
          accounts and subaccounts.
GRM    18 Print and display a listing by grant account
          of reporting requirements including due
          dates.
GRM    19 Print a listing of all grant accounts
          including:
  ID        DESCRIPTION                                      STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            a. Original grant
            b. Total expensed
            c. Outstanding balance
            d. Percent utilized month-to-date
            e. Percent utilized year-to-date
GRM    20   Carry forward grant account and
            subaccount balances into the next fiscal
            year. Previous year's expenditures should
            be maintained on file for inquiry and
            reporting.
GRM    21   Provide "what if" calculation for items such
            as increases in salaries and indirect
            expenses.
GRM    22   Provide automatic across-the-board
            changes to salary expenses by a user-
            defined percentage increase.
GRM    23   Display and print on demand a listing by
            subaccount of month and year-to-date
            grant expenses.
GRM    24   Support multiple (e.g., at least five) budgets
            per grant.
GRM    25   Provide user-friendly menu-driven options
            allowing easy access, editing, and updating
            of information.
GRM    26   Provide a batch interface to a foreign
            General Ledger application.
GRM    27   Provide integrated word processing
            features, including cut and paste text
            editing, spell checking, insertion, and
            deletion.
GRM    28   Provide user-defined fields to capture
            MHD/DADS-specific data elements.
                           FORM A
          FUNCTIONAL REQUIREMENTS
              (GRM) Grants Management
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
STOM, W=WON'T BID
          COMMENTS
STOM, W=WON'T BID
          COMMENTS
STOM, W=WON'T BID
VENDOR      [Enter Vendor Name Here]                                                          FORM A
                                                                             FUNCTIONAL REQUIREMENTS
                                                                                         (PFI) Patient Finacial
  APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                      Analysis
    A=      [Enter Application A Here]                            D= [Enter Application D Here]
    B=      [Enter Application B Here]                            E= [Enter Application E Here]
    C=      [Enter Application C Here]                            F= [Enter Application F Here]

    ID      DESCRIPTION                                     STATUS*    SOURCE COMMENTS
  *STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID

   PFI 1    Ability to custom design financial analysis
            worksheets to determine a clients ability to
            pay.
   PFI 2    Experience building the California Uniform
            Method of Determining Ability to Pay
            (UMDAP) worksheet in the proposed
            system.
   PFI 3    Capture California State determined Client
            Share of Cost and Date of Clearance as
            determined by the UMDAP worksheet.

   PFI 4    All required data that has already been
            collected during the preregistration and
            registration process are automatically
            loaded into the PFI screen.
   PFI 5    Able to copy PFI / Insurance / Fund source
            information and client demographic
            information from one departmen's (e.g.,
            DADS) PFI screens to another
            Department's (e.g., MHD).
   PFI 6    List all existing PFI analyses to include the
            following:
            a. Chronologically, most current first
            b. Department source of PFI
            c. Date / Time
            d. Analyst that performed the PFI
   PFI 7    Capable to load/build California State
            MediCal eligibility logic to determine client
            eligibility.
   PFI 8    Ability to automatically produce required
            State MediCal enrollment forms for filling
            out by the Client.
   PFI 9    Allowed to identify multiple fund sources
            and assign Coordination of Benefit ratios.

   PFI 10 All identified fund sources automatically are
          loaded into the billing generating process.
PFI 11 Update/Change security access can be
       controlled as per user rules to disallow
       inappropriate changes in PFI data after it
       has been completed. Rules to include:
       a. Role (I.e., PFI Analyst only)
       b. Department (I.e., DADS only, MHD only)
VENDOR     [Enter Vendor Name Here]




APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
   A=    [Enter Application A Here]                                       D= [Enter Application D Here]
   B=    [Enter Application B Here]                                       E= [Enter Application E Here]
   C=    [Enter Application C Here]                                       F= [Enter Application F Here]

   ID      DESCRIPTION                                              STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           GENERAL SYSTEM FEATURES
 PAM 1 Accommodate at least seven multiple hierarchical
       entities including:
       a. Department (MHD / DADS)
       b. Health Center
       c. Clinic
       d. Site
       e. Program
       f. Sub-program
       g. Provider team
 PAM 2 Provide separate receivables management systems
       and reporting within each hierarchical entity.

 PAM 3 Automatically roll up multiple entities into a
       corporate reporting structure for all revenue, log,
       and receivable reports.
 PAM 4 Record separate revenue, income, and receivables
       for inpatient, outpatient, residential facility, provider,
       and program by corporate entity.

 PAM 5 Provide tape-to-tape or system-to-system electronic
       claims processing and remittance advice for all
       major payers including Medicare, MediCal, Blue
       Cross, and Commercials.
 PAM 6 Able to generate claims, coordination of benefits,
       and encounter transactions using the ANSI X12
       Version 4010 837 transaction standard.
 PAM 7 Able to receive remittance advise and claims
       payments in the ANSI X12 Version 4010 835
       transaction standard.
 PAM 8 Maintain and use the following code set standards
       in relation to the generation of claims:
       a. ICD9-CM
       b. HCPCS
       c. DSM-IV
       d. CPT-4
 PAM 9 Access demographic and insurance/fund source
       information from one institution or entity, and
       automatically copy for multiple entities (See PRE).

 PAM 10 Access and update client patient accounting data in
        any corporate entity from a single terminal.

 PAM 11 Transfer accounts and messages through an online
        mailbox facility.
   ID      DESCRIPTION                                             STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 12 Limit user security clearance to specific entities or
        tiers within the corporation (See SEC).
 PAM 13 Print demand bills, statements, insurance claims,
        and account detail at designated local printers, or
        access them online.
 PAM 14 Print user selected reports at local printers on
        demand, or based on an arranged schedule.
 PAM 15 Build, update, and delete all system profiles and
        master files online.
 PAM 16 Edit all profile and master file transactions on an
        online, real-time basis against set system
        parameters, syntax, and logic.
 PAM 17 Define up to a minimum of 36 different collection
        codes for reporting purposes.
 PAM 18 Provide automated system file balancing reports
        that do not require manual calculation.
 PAM 19 Accommodate a minimum of 11 digits for the client
        account number, exclusive of check digits.
 PAM 20 Able to enter charges, payments, and adjustment
        transactions into the system on an online, real-time
        basis.
 PAM 21 Capability to bulk load remittance tapes to the
        accounts receivable system, and apply payments to
        individual accounts.
 PAM 22 Proposed system captures and reports separately
        the following:
        a. Gross billing rate as calculated by the system
        b. Negotiated provider rate.
        c. State Maximum Amount (MediCal)
        d. Actual payment
        e. Expected reimbursement as reported via
        remittance advice.
        f. Cost
 PAM 23 View full charge, adjustment, and payment detail
        online on demand, or print on demand through the
        life of the account, including purge restoration (e.g.,
        detail description, posting date, service data,
        quantity, ordering location, dollar amount, revenue
        collection, etc)
 PAM 24 Automatically assign each client an insurance and
        client collector at the point of registration. At user's
        option, assignment may be based upon criteria
        listed below:
        a. Alphabetic sort
        b. Insurance plan (either unverified or verified)
        c. Dollar balance (after charge generation has
        occurred)
        d. Collection status
        e. Financial class
        f. Entity / Program
 PAM 25 Download to a microcomputer any system file and
        format it for manipulation by off-the-shelf software
        including the following formats:, such as MS Excel,
        MS Access, etc.
        a. MS Excel
   ID      DESCRIPTION                                             STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           b. MS Access
           c. Comma delimited text
           d. SPSS
 PAM 26    For each client, access client receivable information
           for a specific provider program and episode as
           determined by the user upon requesting the
           information. Display online, or print on demand, or
           at an arranged schedule.
 PAM 27    For each client, access all client receivable
           information as one view (I.e., across multiple
           provider locations and episodes). Display online, or
           print on demand, or at an arranged schedule.
 PAM 28    At month-end, generate a view to accept and
           segregate payments and adjustment postings by the
           following accounting periods:
           a. Current month
           b. Previous month
           c. All 12 months in accounting year
           d. Accounting periods (I.e., 13 periods)
 PAM 29    Enter charge, payment, and adjustment data, and
           view online pertinent client demographic and
           financial information on the same screen.
 PAM 30    At users option, able to view financial data by
           accounting period (i.e., 13 periods) or by calendar
           month.
 PAM 31    At user's option, use defaults for date of service,
           date of entry, department, and transaction codes
           when posting charges, payments, and adjustments.

 PAM 32 Maintain multiple receivables files and journals as
        defined by the MHD/DADS (e.g., contract providers,
        residential care locations, county providers, etc.).

 PAM 33 Select the appropriate code from an online HELP
        screen for all coded fields, and have it automatically
        appear in the field in question.
 PAM 34 Label all charges, payments, adjustments, memos,
        and other transactions that are performed online
        with the ID code of the staff member performing the
        entries.
           CHARGING
 PAM 35 Maintain and Update prices in the Price Master by
        dollar or percentage at the following levels:
        a. Provider
        b. Program
        c. Department
        d. Revenue or cost center
        e. Service code
        f. Other user definable levels accessing any
        available data element
 PAM 36 Set effective date and expiration date for prices.
 PAM 37 Maintain multiple prices for a charge code as
        determined by the user. To include at a minimum
        the capability to record and charge the following
        prices:
   ID      DESCRIPTION                                            STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
        a. Estimated Cost
        b. Reconciled actual cost
        c. Gross Medical Billing rate
        d. Negotiated contract provider rate
        e. State Maximum Amount (SMA)
 PAM 38 Accommodate historical Price Master that contains
        prices for ten years and associated effective dates.

 PAM 39 Able to access and update Charge Description
        Master and Price Master online.
 PAM 40 Accommodate charging for clients of affiliated
        organizations by utilizing a list bill and 'internal
        pricing' that does not generate accounts receivable.

 PAM 41 Print reports either on demand or on a prearranged
        schedule showing number of days between service
        date and posting date, service date and close date,
        service date and billing date, billing date and pay
        date, for all service areas.

 PAM 42 Automatically edit for missed charges on flexible
        combinations of parameters including the following:

        a. Diagnosis code (I.e., DSM, ICD9)
        b. Procedure codes (I.e., CPT)
        c. Scheduled visit in resource scheduling module,
        but no visit charge code
        d. existence of another charge code in the account
        that indicates there should be another (e.g.,
        Anethesia charge, but no O.R. charge)
 PAM 43 Allow user to specify zero prices to track statistical
        volume via charging.
 PAM 44 Provide detail as well as summary charge
        description capabilities with a user option as to
        which one will print on client and insurance bills. For
        example, panels and exploding charge codes.

 PAM 45 Automatically adjust for retroactive activity:
        a. Close visit in error
        b. Discharge in error
        c. Late charges
        d. Fund source changes
 PAM 46 Delineate actual service date and date of charge
        posting at a detail charge transaction level. It
        should not be assumed that the service date is the
        posting date or vice versa.
 PAM 47 Allow authorized users to override charge code
        prices at the time of posting. Enable the capture of
        the user ID performing the override and notes to
        capture the reason for the price override.
 PAM 48 Capability to bulk load service volume for posting
        from other billing systems or affiliated and
        contracted providers.
   ID      DESCRIPTION                                           STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 49 Generate list of transactions that have been posted
        and rejected, as well as, error code of rejection by
        batch type, user, and location.
 PAM 50 Place rejected batch transactions in a queue and
        allow the user to correct all errors and re-post
        transactions online.
 PAM 51 Automatically assign CPT-4/HCPCS codes for each
        relevant charge description master code.
 PAM 52 Provide for the automatic generation of visit charges
        based on the following events:
        a. At the time of visit schedule
        b. At the time of client visit
        c. At the time of closing of the visit
 PAM 53 Charge for items/services based on information
        entered at time of preregistration such as Intake and
        Assessment activity at the time of the following
        subsequent events.
        a. Registration / Admission
        b. Episode open
 PAM 54 Provide for automatic charge explosion capability,
        where one charge can explode into multiple detail
        charges.
 PAM 55 Code General Ledger reference keys at the
        transaction level to enable revenue posting to the
        general ledger appropriately.
           INSURANCE ELIGIBILITY AND VALIDATION
 PAM 56 Enter online client insurance/fund source
        information (e.g., insurance code, policy numbers,
        and benefit information)
 PAM 57 Automatically carry forward fund source data
        captured and generated on the Patient Financial
        Information screen(s) (see PFI).
 PAM 58 Automatically provide online insurance default
        benefits for all major insurance types.
 PAM 59 Change default benefits online at the time of
        registration.
 PAM 60 Capture effective, termination, and insurance
        recertification dates online.
 PAM 61 Perform online validation checks of Medicare and
        MediCal numbers and eligibility (see OCE).
 PAM 62 Add/delete/modify/reject client's insurance coverage
        online, as needed.
 PAM 63 Print on demand, or on prearranged notification,
        reports listing those clients that are reaching a
        termination or recertification date in "X" days (where
        "X" is user-defined).
 PAM 64 Record insurance benefits online at the service level
        (e.g., group therapy, assessment and evaluation,
        inpatient days, etc.) for individual clients.

 PAM 65 Allow for online entry of free format comments of
        not less than 500 characters on the insurance
        benefit screen.
   ID      DESCRIPTION                                            STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 66 Automatically generate summary financial class
        group code based on verified detail insurance plan /
        fund source type.
 PAM 67 Indicate online, or print a report at user's option, of
        which charges are non-covered for a particular
        insurance.
 PAM 68 Specify for Medicare deductibles as well as, other
        insurance deductibles automatically taken on a
        weekly, monthly, or periodic basis.
 PAM 69 Capture online all data required to meet Federal,
        California State, and local and third-party billing
        requirements for all client types (e.g., inpatient,
        residential care, outpatient, etc.). Evidence of
        California MediCal experience will be important to
        evaluation..
 PAM 70 Record authorization numbers and effective dates
        as required by each third party.
 PAM 71 Provide online ANSI X12 278
        authorization/certification request generation
        capabilities.
 PAM 72 Print audit reports of all changes, additions,
        deletions, and rejections for all insurance file
        information. Specifically show the following:
        a. Date of change
        b. ID of clerk making change
        c. Field image before change
        d. Field image after change
        e. Capture online insurance mailing address.
 PAM 73 Accommodate upto four active insurance
        coverages/fund sources simultaneously.
 PAM 74 Print reports showing which clients have unverified
        insurance by aging category, plan type, and financial
        class.
           PRORATION AND BILLING
 PAM 75 Accommodate automatic small balance late charge
        write-off by fund source.
 PAM 76 Generate year-end late charge reconciliation reports
        showing full client and transaction detail by payer.

 PAM 77 Accommodate daily proration of account balance.

 PAM 78 Display online insurance proration spread for each
        charge transaction.
 PAM 79 Accommodate an invoice number for each
        insurance claim.
 PAM 80 Provide automatic insurance prorations and
        coordination of benefits of up to a minimum of four
        insurances based on user-specified algorithms.
   ID      DESCRIPTION                                           STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 81 Automatically calculate and report, as defined by the
        user, contractual allowances (per diem, percentage,
        share of cost, or other) for all third-party payers,
        including Medicare, MediCal, Blue Cross, and
        commercial plans in the following situations:

        a. Default benefits
        b. Unbilled but verified
        c. Billed not paid
        d. Paid
 PAM 82 Comply with Federal uniform billing ANSI X12 837
        requirements in a tape or CPU-to-CPU format.

 PAM 83 Schedule inhouse cycle billing based on financial
        class and activity, and client type.
 PAM 84 Print demand bills and statements on an online real-
        time basis at a local printer.
 PAM 85 Automatically reprorate/rebill those accounts that
        have insurance plan or benefit changes through the
        life of the account.
 PAM 86 Accommodate retroactive changes in insurance
        benefit data or late charges after generation of final
        bill, and reflect changes in all financial and
        interfaced systems and reports.
 PAM 87 Bill client for remainder of charges after all options
        for third-party payment are exhausted, unless user
        specifies that self-pay balance should be billed at
        same time as insurance bill.
 PAM 88 Bill one fund source and automatically bill second
        for the remainder of balance after posting payment
        or rejection to first fund source. Continue for as
        many sources as reported for client until balance is
        zero or amount is transferred to client or written off
        as bad debt/unsponsored services.

 PAM 89 Identify client as either one-time or recurring
        outpatient. Recurring outpatients should have a
        single billing account number.
 PAM 90 Until X12 837 becomes the billing standard,
        accommodate separate bill form edits for each
        insurance type and financial class, and provide
        rejection reporting capability at the field level.
 PAM 91 Print an edit report flagging final bills being held
        because of insufficient data or error in data (e.g.,
        missing UPIN# or other edits) by client type,
        financial class, insurance, and bill form field.
 PAM 92 Maintain online all charges, credits, allowances,
        payment detail, and memos until balance reaches
        zero; then at users option provide for archival
        storage on readily accessible media.
 PAM 93 Print inquiry forms on demand, or cycle for payers
        based on non-payment conditions.
 PAM 94 Print summary bills in addition to, or instead of,
        detailed bills, based on MHD/DADS/insurance
        carrier specifications.
   ID      DESCRIPTION                                              STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 95 Print client statements at the point of service.
 PAM 96 Automatically generate interim and final insurance
        bills upon completion and acceptance of required
        elements, as determined by MHD/DADS (e.g.,
        diagnosis completion, MediCal eligibility verification,
        etc.).
 PAM 97 Automatically track the billing status of all clients
        including Medicare, MediCal, Blue Cross, and
        commercial clients (e.g., days remaining,
        deductible, response from carrier), and issue follow-
        up inquiries as defined by the user.
 PAM 98 Post payment advances or deposits on unbilled
        client accounts and automatically update balances.

 PAM 99 Accept free text in messages on all bills, including
         variable/standard messages, based on financial
         class, activity, account age, dollar balance, and
         client status code.
 PAM 100 At user's request, automatically write-off small
         balances based on user-specified criteria.
 PAM 101 Allow each client type (e.g., inpatient, residential
         care, outpatient, emergency room, etc.) to have
         different client bill and statement formats with
         different messages.
 PAM 102 Automatically apply preadmission deposits to a
         client's account although charges may not yet exist.

 PAM 103 Automatically transfer admitted clients who have
         canceled admissions and have incurred admission
         test charges to outpatient status after a user-defined
         number of days.
 PAM 104 Modify the final billing suspense period after
         discharge/visit by:
         a. Individual client
         b. Third-party payer
         c. Client status codes as defined by the user
         d. Client type (inpatient, residential care, outpatient,
         emergency room, etc.)
         e. Any user-defined criteria based on available data

 PAM 105 On client bills, show which charges or portions of
         charges will be covered by a fund source and which
         are client responsibilities or unsponsored. Bills are
         printed in a multiple column client bill/statement
         format showing total charge, primary and secondary
         sources.
 PAM 106 Generate separate fund source accounts receivable
         so revenue is appropriately delineated in the A/R
         subsytem and in the general ledger.
 PAM 107 Display online estimated client responsibility
         portions based on fund source proration for unbilled
         accounts. Automatically flag charges that are not
         covered or partially covered by the third parties.
   ID      DESCRIPTION                                               STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 108 Display online a single summary for the totals of the
         following:
         a. Charges
         b. Adjustments / Allowances / Writeoffs
         c. Payments
 PAM 109 Automatically calculate and post contractual
         allowance based on third-party specific
         requirements, either on billing or payment at the
         discretion of MHD/DADS.
           CREDIT AND COLLECTION/ WORK FILE
           SYSTEMS
 PAM 110 Provide an online, real-time profile-driven collection
         system that will automatically generate such
         account activity as adjust transactions, produce
         statements, rebill insurances, and create client
         correspondence, based upon management-defined
         criteria.
 PAM 111 Automatically select accounts and assign them to
         specific collector's Work Files based upon any one
         or a combination of the following account
         characteristics:
         a. client type
         b. Third party
         c. Minimum and maximum account balance
         (insurance or client)
         d. Minimum and maximum account age
         e. Minimum and maximum dunning level
         f. Alphabetic range of client or guarantor last name

         g. Future follow-up date
         h. Last follow-up date
         I. Bad debt status
         j. Selected transaction codes
         k. client status codes
         l. DSM code
         m. ICD-9-CM code
         n. CPT4 code
         o. Financial class
         p. Employer code
 PAM 112 Generate collector online work files on a weekly
         basis. System can assign certain types of accounts
         on certain days of the week.
 PAM 113 Sort Work File accounts based upon multiple
         selection criteria (e.g., client name, program, facility,
         age of account, outstanding balance, fund source).

 PAM 114 Create a minimum of two hundred different Work
         Files for a weekly cycle.
 PAM 115 Allow up to 500 accounts per Work File.
 PAM 116 Automatically queue accounts for a Work File in a
         priority order for collectors based upon parameters
         set by management (e.g., high-to-low invoice
         balance, insurance plan, account age, last follow up
         date, account status code, etc.).
   ID      DESCRIPTION                                             STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 117 Provide ability to enter and review the following
         types of activity on an online, real-time basis:
         a. All transactions
         b. System mail messages
         c. Follow-up notes and dates
         d. Contractual arrangements for payment
         e. Additional insurance information
         f. Insurance reprorations, rebillings, and letters
         g. Demand client bills, statements, or letters
         h. Changes in dunning levels
         I. Changes in dunning messages
         j. Account transfers to bad debt
 PAM 118 Collect complete detail in the account history for the
         life of the account. Details will include who initiated
         the action, type of action taken (e.g., rebill sent),
         how much, which insurance balance was
         transferred to the client, which special letter wa

 PAM 119 Define profile-driven codes for standard messages
         and memos on the Work File system (e.g., no
         answer, phone busy, promised to pay in one week,
         check is in the mail, will send additional insurance
         information, or requests rebill).

 PAM 120 Automatically generate personalized client type,
         financial class, and insurance specific letters at
         either fixed intervals or at the prompting of
         collectors.
 PAM 121 Provide for terminal autodialing capability with line
         signal detection to selected phone numbers (e.g.,
         client, guarantor, employer, or next of kin).
 PAM 122 Prohibit signoff on a Work File account unless a
         certain type of management-defined profile-defined
         activity takes place (e.g., an entry of a message with
         a new follow-up date, generation of a client
         statement, an insurance inquiry letter or rebill).

 PAM 123 Allow Work File messages (such as line busy or no
         answer) to cause the account to automatically
         recycle in the queue in a profile-determined amount
         of time.
 PAM 124 If the number of selected accounts for a Work File
         is less than the total eligible account population,
         automatically print management report listing those
         accounts which have been excluded.

 PAM 125 Automatically print weekly collector productivity
         reports, providing management details by Work File
         and collector, of the number of accounts processed
         or not processed, number of rebills/statements sent
         out, contractual arrangements made for what
         amount,
 PAM 126 Exclude certain accounts from the Work Files and
         provide a report of those accounts, with a status
         code denoting the reason.
   ID      DESCRIPTION                                             STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 127 Accommodate collector teams for designated Work
         Files.
         CREDIT AND COLLECTION/ GENERAL
         COLLECTION SYSTEMS
 PAM 128 Provide separate receivable for each insurance bill.

 PAM 129 Provide an online message mailbox for each
         collector.
 PAM 130 Provide bad address indicator that automatically
         stops client bills or statements.
 PAM 131 Automatically create client accounts at time of
         preadmission.
 PAM 132 Transfer account balances from one account to
         another, as well as combine accounts, for family
         and guarantor billing or duplicate account number
         situation, and print audit reports of all such
         transfers.
 PAM 133 Transfer accounts keyed to be turned over to
         Collections, to a prelist for management review. If
         no manual holds are placed within seven days,
         automatically transfer to Collections file.
 PAM 134 Allow user to transfer an account to a collection
         agency any time after final billing.
 PAM 135 Provide for generation of a report from third-party
         payment tape reflecting remittances, denials, and
         pendings.
 PAM 136 Provide an online account level audit trail for all
         memo, payment, and adjustment transactions,
         indicating date of transaction, type, and detail.
 PAM 137 Provide stop bill and statement capability.
 PAM 138 Print reports of those clients not receiving bills or
         statements due to use of "stop" status code.
 PAM 139 Allow dunning and aging on the following bases:
         a. Weekly
         b. Biweekly
         c. Monthly
         d. Bimonthly
         e. Accommodate contract payment schedules.
 PAM 140 Print list of delinquent receivable accounts that have
         exceeded user's grace period for payment since
         final billing.
 PAM 141 Print list of all clients who have failed to meet their
         agreed contract payments and schedule.
 PAM 142 Provide automated receivable tickler file to monitor
         Collection Agency activity.
 PAM 143 Charge interest to late accounts, based on user-
         specified criteria.
 PAM 144 Define the number of days (minimum of 30 days) for
         which a zero balance account should appear on
         reports before transfer to archival file.
 PAM 145 Reset client account aging indicators online.
 PAM 146 Allow for bad debt recoveries and reversals online.

 PAM 147 Stop or override specific messages and restart
         follow-up statements online.
   ID      DESCRIPTION                                             STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 148 Print collection letters using different user-specified
         formats, selected on the basis of outstanding
         amount, age of account, and number of previous
         attempts to collect.
 PAM 149 Store variable free text dunning message which can
         be selected and used automatically at different
         times in the collection cycle, if the standard
         message is to be overridden.
 PAM 150 Automatically transfer to a collection agency those
         accounts that meet profile-specified criteria.

 PAM 151 Generate tape of all accounts designated for
         transfer to one or more collection agencies. This
         tape/extract must meet the California State
         Department of Revenue formating requirements.
 PAM 152 Automatically create a separate receivable for those
         accounts that are in collection. Automatically credit
         active receivable and debit collections receivable.

 PAM 153 Allow full inquiry of all account detail in collections
         receivable.
 PAM 154 Maintain collections file, including demographic
         information, total charges, Collection Agency
         handling account, financial class, and
         transaction/payment detail.
 PAM 155 Automatically identify potential bad debts for
         management/Collector review based on user-
         specified criteria (e.g., age of account, dollar,
         financial class, etc.).
 PAM 156 Allow the user to determine account aging by one of
         the following:
         a. Date of admission
         b. Date of discharge
         c. Date of bill generation
         d. Date bill is mailed
         e. Date of last payment
 PAM 157 Remove disputed charges on a particular account
         online from the client's receivable balance and hold
         in suspense until resolution. The contested amount
         will still appear on the client statement on a special
         line.
 PAM 158 Allow online review of all accounts prelisted to bad
         debt. Access to full payment/adjustment (account)
         detail will be provided as part of the review process.

 PAM 159 Automatically create specific profile-driven
         parameters specifying by collector the type and
         limits of the activities they may perform (e.g., write
         off levels, use of certain transaction codes,
         collection agency referral limitations).
 PAM 160 Allow collectors to transfer accounts on the system
         to supervisors for online review.
   ID      DESCRIPTION                                            STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 161 Provide a minimum of 500 characters of free form
         memo space for each internal collector notes. Each
         inpatient (including residential care) admission and
         outpatient episode can have an unlimited number of
         notes.
 PAM 162 Produce an online report for each account when a
         collection agency is assigned, reproducing full
         demographic, insurance, transaction, and memo
         detail. This report will be turned over to the
         collection agency.
         CASH POSTING
 PAM 163 Post payments and adjustments in real-time to
         individual accounts or in a batch screen mode.
 PAM 164 Print a variance report, either on demand or in batch
         mode at user's discretion, highlighting differences in
         paid and billed covered days/treatments, co-
         insurance amounts, and deductibles.

 PAM 165 Print on demand pre-numbered client receipts at
         local printers.
 PAM 166 Print online or demand batch report showing source
         of income.
 PAM 167 Print a list of all cash receipts and adjustments.
 PAM 168 Post non-client payments (e.g., cafeteria monies
         and grant checks) which are automatically passed
         and posted to the General Ledger.
 PAM 169 Provide online real-time batch reconciliation for
         payments, adjustments, and charges utilizing item
         count and dollar amount of the batch.
 PAM 170 Provide for tape-to-tape and CPU-to-CPU posting of
         remittances, denials, pending, and payments for all
         accepting payers.
 PAM 171 Capable of receiving ANSI X12 835 remittance
         advice format.
 PAM 172 Capable of sending and receiving ANSI X12
         276/277 claims status and response transactions.

 PAM 173 Automatically transfer client refunds to Accounts
         Payable for accounts identified to have refunds
         paid.
 PAM 174 Post payments to individual interim or outpatient
         episodes or group episodes.
 PAM 175 Allow for FIFO cash posting across multiple open
         accounts.
 PAM 176 Allow for partial payments on both inpatient
         (including residential care), outpatient, and group
         insurance receivable balances.
 PAM 177 Provide online real-time cash reconciliation routines.

 PAM 178 Post payments with system-assigned invoice
         numbers.
 PAM 179 Provide online real-time reasonability checks on
         payments applied, such as payment amounts
         greater than balance of account.
   ID      DESCRIPTION                                               STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 180 Accept payments at decentralized cashiering areas.
         Detailed client receipts can be generated on a real-
         time basis through local printers.
 PAM 181 Print or display (at user's option) a list of all payment
         batches (generated either at the cashiers or at cash
         applications) that are still open as a result of not
         being balanced.
         REPORTING
 PAM 182 Print the following aged account lists with total,
         insurance, and client account balances where
         applicable:
 PAM 183 Unbilled client accounts for discharged clients,
         including reason for unbilled account (e.g., missing
         final diagnosis)
 PAM 184 Accounts with balances over "X" amount
 PAM 185 Accounts with credit balances specified by user
 PAM 186 Receivables aging report from date of last payment
         date, showing client name, account number,
         amount and days outstanding, and number of
         accounts for each collection clerk
 PAM 187 Accounts, based on MHD/DADS-specified criteria,
         that are candidates for turnover to Collection
         agencies, including client name/address/ telephone
         number, client account number, and dollar amount
         due
 PAM 188 Clients with late charges
 PAM 189 Code Directory (e.g., diagnostic, charge description)

 PAM 190 Print listing of unbilled insurance accounts by
         insurance type, plan, aging category, financial class,
         and employer code, with reason for unbilled status.

 PAM 191 Print monthly activity summary of departmental
         charges on a month-to-date, and year-to-date basis,
         including volume and dollars by financial class.

 PAM 192 Print report of month-to-date or year-to-date
         revenue, including number of admissions, length of
         stay, and client days.
 PAM 193 Print report of client revenue, including retroactive
         reclassification to reflect changes in financial class.
         Show beginning balance, debits, credits, and ending
         balance at client and summary levels.

 PAM 194 Print third-party logs for Blue Cross, Medicare,
         MediCal, and other third parties to meet Federal,
         State, and local reporting requirements (e.g., RCC,
         ICR).
 PAM 195 Print reports of Collection Agency performance
         showing percent of accounts settled, dollar amounts
         of settlements, and percentage of total outstanding
         amounts collected.
 PAM 196 Generate required Medicare and MediCal bad debt
         logs and reports.
   ID      DESCRIPTION                                              STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 PAM 197 Print client days report for Medicare clients under 65
         years of age.
 PAM 198 Print a revenue report by location, client type,
         hospital service, and financial class.
 PAM 199 Print a deduction from revenue report by
         program/provider, client type, service type, financial
         class, and type of write-off. (e.g., denial, contract
         term)
 PAM 200 Print report showing dollars outstanding, average
         days to billing, and average days to payment, with
         detailed client information.
 PAM 201 Print a summary and detail list of all clients with zero
         balance accounts that have not been purged.

 PAM 202 Provide third-party log report files that are identical
         to account receivable billing files in terms of account
         detail.
 PAM 203 Print weekly report monitoring biller activity (e.g.,
         number of bills prepared or accounts handled within
         specified timeframe).
 PAM 204 Print weekly report of unbilled accounts by biller.
 PAM 205 Print daily report of unbilled accounts due to
         attestations, sorted by physician.
         BILLING AND VALUATION
 PAM 206 Provide for insurance receivable valuation at the
         program, per diem, and percentage rates for both
         billed and unbilled accounts.
 PAM 207 Automatically calculate the estimated contractual
         allowances based on multiple scenarios (e.g.,
         allowable costs, capacity based, FFS, grant based,
         etc) for month-end receivable valuation.

 PAM 208 Highlight day and cost outliers through daily
         reporting.
 PAM 209 Display appropriate descriptive verbiage next to
         each ICD-9-CM, CPT4, and DSM code.
         MANAGED CARE
 PAM 210 Maintain contract detail on up to 100 different
         managed care arrangements.
 PAM 211 Record preauthorization information as required by
         each third party.
 PAM 212 Generate reminders where preauthorization has not
         been received based on contract specific
         requirements.
 PAM 213 Enable electronic claims submission where
         available by contracting party.
 PAM 214 Generate statistical reports to show client activity,
         revenue, and receivable for each contract, provider,
         and program.
 PAM 215 Automatically calculate contractual allowances and
         post based on individual contract requirements.

 PAM 216 Satisfy other reporting requirements of each
         contracting party.
                                FORM A
               FUNCTIONAL REQUIREMENTS


                      (PAM) Patient Accounting
                                  Management
nter Application D Here]
nter Application E Here]
nter Application F Here]

            COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
COMMENTS
VENDOR [Enter Vendor Name Here]
                                                                                        FUNCTIONAL REQUIREMENTS
                                                                               (PCM) Payer Contract Management and
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                                 Negotiation Support
     A=   [Enter Application A Here]                                     D= [Enter Application D Here]
     B=   [Enter Application B Here]                                     E= [Enter Application E Here]
     C=   [Enter Application C Here]                                     F= [Enter Application F Here]

ID        DESCRIPTION                                              STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          CONTRACTING
          The system should have the ability to support the
 PCM 1
          following payment methods:
          a. Discount from charges (variable by revenue code,
          CPT-4 code or ICD-9-CM code)
          b. Simple and multitiered per diem defined by
          room/bed of patient, and/or service lines.
          c. Per case/episode
          d. Fee-for-Service
          e. Per Member Per Month
          The system should allow the user to define
 PCM 2    groupings of payors for modeling or reporting
          purposes.
          The system should allow the user to perform "what
          if" analysis of potential new rates, new payment
          methods, or utilization changes. These new
 PCM 3
          parameters should be processed against the actual
          patient mix for that contract over a specified period.

          The system should allow calculation of expected
 PCM 4    gross and net revenue based on past patient mix
          but at variable volume levels.
          Standard monthly (and on demand) reports should
          be provided which summarize all managed care
          activity for a specified period. Information should
 PCM 5
          include plan name/number, volume, charge, and
          allowances. Activity should be shown in total and
          also by program
          The system should automatically generate a
          renewal calendar showing key dates for each
 PCM 6    contract, including expiration date, cancellation
          notification date, and a user defined date to initiate
          renegotiation.
         The system should accept cost accounting
         information at the procedure level by product line,
         physician group, department, individual charge
         code, split by fixed and variable component for
         each. This cost information should be used to
PCM 7
         produce analysis reports of contract profitability.
         The system should allow cost accounting methods
         which vary by hospital. Actual cost may be entered
         either as a dollar amount or percentage of billed
         charges.

         The system should store data linked to specific
         contracts, all payor types, and plans. The system
PCM 8    should then allow the use of this data to monitor that
         contract on specific patients (determining criteria
         needed to obtain payment, which criteria have been
         met, which criteria have not been met).
         The system shall have the ability to estimate the
PCM 9
         impact of mix changes on reimbursement.
         The system shall provide automatic identification of
PCM 10
         Medicare outliers.
         A modeling database should be part of the system
PCM 11
         for "what if" analysis.
         The user may define product lines and service units
PCM 12
         for analysis and reporting.
         The product lines or service units may be changed
PCM 13
         by the user after initial start-up.
         The system will maintain the following information
PCM 14
         for each managed care contract:
         a. Name, address, contact persons, and phone
         number of plan
         b. Contract persons and phone numbers (at least
         two)
         c. Other names of the plan
         d. Term of the contract (start/end dates; multiple
         start/end dates for same contract)
         e. Renewal provisions (i.e., automatic or on notice of
         intent and length of notice period)
         f. Plan code
         g. Precertification organization, address, and phone
         number
         h. Precertification requirements
         i. Payor address and phone number
         j. Billing address and phone number

         k. Payment method type and parameters by patient
         type (including but not limited to: percent of
         charges; single and multiple per diems; per case;
         pass through items; and stop loss clauses)
         l. Utilization Management criteria
         m. Payment timeliness requirements
       n. Type of contract (HMO, PPO, Medicare,
       Medicaid, etc.)
       o. Coordination of benefits information
       p. Payment denial rules
       The system stores a minimum of 999 different
PCM 15
       contracts.
       Historical contract data, such as volumes, revenues,
PCM 16 claim rejections and payment history, can be
       maintained and reported on.
       Rates and formulas should be maintainable by end
PCM 17
       users, not programmers.

         Contract terms and conditions including covered
PCM 18
         and noncovered sources and UM requirements
         should be available online to all with a need to know.
         CONTRACT MODELING AND ADMINISTRATION

         Simulate unlimited contract rate variations ranging
PCM 19
         from simple discounts to full risk capitation with any
         combination of rate and terms.

PCM 20 Provide modeling to the line item level to determine
       effects of stop losses, passthroughs, etc.
       Evaluate stop losses, co-insurance, passthroughs,
PCM 21 volume discounts, per diems, percentages,
       maximums, minimums, etc.
       Model multiple stop loss mechanisms for all
PCM 22
       contracts.
PCM 23 Passthrough high cost line items.
       Handle rebundled reimbursement for Laboratory,
PCM 24
       pharmacy, etc.
       Unbundle specific clinical services in price
PCM 25
       negotiations.
       Compare different rates by services provided across
PCM 26
       contracts and to regional averages.
       Provide comparative pricing data regional and state
PCM 27 highs, lows, and averages for high volume (or any)
       procedures.
       Provide summary of significant contract terms for
PCM 28
       administrative approval.
       Track and report contract action dates, contact
PCM 29
       names, phone numbers, and renewal dates.
       The system shall be able to model the impact of
PCM 30
       volume changes by:
       a. Service type
       b. Payor/Contract
       c. Program
       d. Provider
       Provide features to manage full-risk capitation
PCM 31
       plans.
       PROFITABILITY ANALYSIS
         Ranked management reports based upon contract
PCM 32
         volume, profitability, and margins.
PCM 33
         Detailed reports of profitability at product line level.
         Determine contribution margins by program and
PCM 34
         service type.
         Utilize cost accounting features to calculate actual
PCM 35
         product line cost (See CAM).
         Pinpoint product lines and other areas of significant
PCM 36
         loss/risk.
         Provide standard measurements for performance
PCM 37   evaluation of contracts, physicians, employers, and
         product lines.
         Produce hard profit/loss data by payor, physician,
PCM 38   physician group, employer, product line, and market
         area.
         Categorize patients into specific status codes for
         improvement in operations (e.g., money lost
PCM 39
         because of no authorization, not being billed
         according to time limits in the contract, etc.).
         Provide for long-term storage for profitability
PCM 40
         analysis, marketing, and planning.
         Interface with cost accounting system to monitor
PCM 41   actual profitability of each contract on inpatient and
         outpatient activity.
         UTILIZATION ANALYSIS
         Provide features to analyze utilization across
PCM 42
         contracts.
         Compare actual utilization to capitated actuarial
PCM 43
         projections.
         Average utilization profiles by charge code for
         specific clinical service by physician specialty,
PCM 44
         individual provider, program, and prepare variance
         analyses.

PCM 45 Ability to calculate denial activity into expected
       reimbursement and monitor denial activity by payor.
PCM 46 Provide ability to monitor appeal activity.
PCM 47 Provide ability to calculate appeal/denial ratio.
                          FORM A
         FUNCTIONAL REQUIREMENTS
 (PCM) Payer Contract Management and
                   Negotiation Support
nter Application D Here]
nter Application E Here]
nter Application F Here]

              COMMENTS
W=WON'T BID
VENDOR [Enter Vendor Name Here]
                                                                               FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                         (CAM) Cost Accounting Management

  A=       [Enter Application A Here]                             D= [Enter Application D Here]
  B=       [Enter Application B Here]                             E= [Enter Application E Here]
  C=       [Enter Application C Here]                             F= [Enter Application F Here]

 ID        DESCRIPTION                                      STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           Maintain corporate entities on an individual
CAM    1
           and consolidated basis.
           Differentiate and maintain cost centers by the
CAM    2
           following types:
           a. Direct patient care
           b. Patient support
           c. Overhead
           d. Revenue-producing departments
           e. Non-revenue producing departments
           Maintain detail for all departments, cost
CAM    3   centers, and subaccounts, in accordance with
           the General Ledger format.
           Maintain a minimum of 99 cost types
CAM    4
           including:
           a. Fixed
           b. Variable
           c. Semi-variable
           d. Direct
           e. Indirect
           f. Overhead
           g. Capital
           h. Salary categories
           I. Non-salary -- hourly
           j. Daily
           k. Ancillary
           l. Support services
           Provide support for an unlimited number of
CAM    5
           cost allocation statistics including:
           a. Procedures and CPT codes
           b. Discharges
           c. Visits
           d. FTEs / Employees
           e. Direct Expeses
           f. Weighted square footage
           g. Cost centers
           h. Departments
           I. Program
           j. Providers
           k. Provider groups
           l. Payors with insurance code detail
           m. Service levels
          n. Account status
          o. User-defined fields
          Provide support for the development of
CAM   5
          standards for cost types by procedure.
CAM   6   Support the following costing techniques:
          a. Ratio of cost to charges
          b. Relative Value Units
          c. Direct costs of chargeable supplies and
          pharmaceuticals
          d. Cost components
          e. Engineered standards
          f. Per Diem
          g. Acuity
          h. Combination of multiple techniques within
          one cost center
          I. Severity of Mental Illness
          j. Activity Based Costing
          k. Other (Please Specify)
CAM   7   Vary costing techniques by:
          a. Program
          b. Department
          c. Intradepartment
          d. Patient/Program Type
          Provide the following types of overhead
CAM   8
          allocations at the Program or Department:
          a. Medicare stepdown
          b. Modified Medicare stepdown
          c. Standard cost allocation
          d. Simultaneous equations
          e. Other options
CAM   9   Allocate the following:
          a. Depreciation
          b. Capital items
          c. Other passthrough items
          d. Fixed and variable components of other
          overhead costs
          e. Medical education
          Support monthly, quarter-to-date, semiannual,
CAM 10    and annual bases for allocations to be
          updated as needed.
          Allow the easy maintenance of allocation
CAM 11
          bases for multiple periods.
          Support cost transfer mechanisms, rules and
          algorithms for distributing costs between cost
CAM 12    centers for services rendered, materials used,
          program specific costs, intra-entity transfers,
          etc..
          Support the ability to „split‟ an overhead cost
          center by user defined parameters (e.g.
CAM 13
          salary and OTPS) for purposes of cost
          allocation.
CAM 14    Provide profit and loss statements by:
          a. System of care as defined by SCVHHS
          b. Program
          c. Group of programs
          d. Payor/insurance/fund source
          e. Provider
          f. Service lines as defined by SCVHHS
          All of the above for the Mental Health, and the
CAM 15
          DADS Departments of SCVHHS.
          Monitor the relationship between the
CAM 16    calculated cost and the price of charge
          description master codes.
          Simulate/analyze the effects of changes to
CAM 17
          costs by:
          a. Volume
          b. Staffing
          c. Efficiency
          d. Cost and impact of new programs
          e. Patient mix
          f. Procedure mix
          g. Payor mix
          Enable the modeling of new programs
CAM 18
          incorporating the following functionality:
          a. Incorporate existing program cost /
          revenue profiles.
          b. Allow „vertical costing‟ that is, bottom up
          cost assumptions for new equipment, new
          personnel, etc..
          c. Allow the combination of new cost
          assumptions from (b) and existing program
          cost profiles.
          Provide the capability to change any and all
CAM 19
          cost, revenue and volume assumptions

       Provide the capability to produce Pro Forma
CAM 20
       profit/loss statements incorporating bad debt
       percentages, and overhead absorption costs.
       Provide charges, profit margins, and
CAM 21
       deductions from revenue by procedure.
CAM 22 Provide the ability to rank:
       a. Diagnoses by total cost
       b. Service Type (e.g., medicationa
       dministration, group sessions, assessments)
       by total profit
       c. Programs by profitability
       d. Programs by volume
CAM 23 All of the above for the total Department
CAM 24
       Support productivity monitoring and reporting.
       Report cost variances against fixed budget
CAM 25
       and flexible budget by:
       a. Cost types
       b. Volume
       c. Service type mix
       d. Prices
       e. Efficiency
       f. Total variance
CAM 26 Generate the following base reports:
       a. Summary of allocation statistics
       b. Summary of allocated costs by natural
       class by cost center
       c. Detailed program reports
       d. Department cost summary
       e. Program total cost
       f. program labor cost summary

       g. Labor cost summary by job code category
       h. Data audit for data quality monitoring
       I. Cost center budgeted cost statement
       j. Program service type level flexible budget
       k. Client group cost profile
       l. Profit and loss by system of care
       m. Profit and loss by fund source
       n. Profit and loss by service type
       Audit report reconciling cost accounting cost
CAM 26
       and charges to the General Ledger
       Maintain historical cost data (at least three
CAM 27
       years) for comparative reporting.
                        FORM A
       FUNCTIONAL REQUIREMENTS

 (CAM) Cost Accounting Management

nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
OM, W=WON'T BID
Managed Care Operations
VENDOR       [Enter Vendor Name Here]
                                                                                       FUNCTIONAL REQUIREMENTS


APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
  A=     [Enter Application A Here]                                       D= [Enter Application D Here]
  B=     [Enter Application B Here]                                       E= [Enter Application E Here]
  C=     [Enter Application C Here]                                       F= [Enter Application F Here]

   ID        DESCRIPTION                                            STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
MEE     1    Provide online entry/update of enrollment and
             eligibility information.
MEE     2    Enable the batch load of an eligibility and
             enrollment data file from the State (I.e.,
             California MEDS file) as well as contracted
             employers.
MEE     3    Enable user to search and retrieve eligibility
             information by ID number, and enrollee name.

MEE     4    Enable user to enter free text information on
             enrollment eligibility screen(s).
MEE     5    Provide eligibility information online including
             eligibility dates, premium rates, and contract
             information for eligibility periods.
MEE     6    Retain historic enrollment/eligibility data files on
             enrollees including intermittent changes.
MEE     7    Able to correlate service utilization, claims, etc.
             to the effective dates of enrollment and
             eligibility history.
MEE     8    System generates unique identification
             numbers for dependents.
MEE     9    System provides alternative name/alias search
             for an enrollee.
MEE     10   Provide access to eligibility information by:
             a. Employer group
             b. Provider
             c. Provider group
             d. Union
             e. Sponsor Agency
             f. Grant/Program
MEE     11   System provides online notification of cut-off
             dates, expiration dates, and COBRA with
             regard to eligibility.
MEE     12   Assign the Primary Care Physician (PCP) using
             the Staff Master list
MEE     13   Provide reactivation of previously terminated
             enrollees and groups without requiring
             reentering all the data.
MEE     14   Maintain enrollment for a single client in
             multiple managed care contracts.
MEE     15   Enrollment data is visible to any workforce
             member with security privileges to see
             enrollment data.
MEE     16   Generate disenrollment report.
MEE     17   Provide for transferring of enrollment data to a
             PC for independent processing.
   ID       DESCRIPTION                                         STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
MEE     18 Provide online access to verify eligibility and
           coverage for the following:
        19 a. Medicare
        20 b. California MediCal
        21 c. Eligibility clearinghouse (Please Specify)
MEE     22 Able to receive and generate HIPAA ANSI
           X12N 270/271 eligibility request and response
           transactions.
           ENROLLMENT LISTS
MEE     23 Updates employer or government member
           enrollments using EDI functions.
MEE     24 Ability to make edits, additions, and deletes
           before accepting the data and affecting the
           database.
MEE     25 Ability to control and hold multiple tape loads in
           queue, review their status, and maintain a
           history.
MEE     26 Able to receive and process HIPAA X12N 834
           Benefit Enrollment and Maintenance EDI
           transactions.
MEE     27 Able to receive and process HIPAA X12N 827
           Health Plan Premium Payment EDI
           transactions.
                        FORM A
       FUNCTIONAL REQUIREMENTS
                        (MEE) Member
                 Enrollment / Eligibility
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
M, W=WON'T BID
           COMMENTS
M, W=WON'T BID
VENDOR      [Enter Vendor Name Here]
                                                                                      FUNCTIONAL REQUIREMENTS


  APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
    A=   [Enter Application A Here]                                   D= [Enter Application D Here]
    B=   [Enter Application B Here]                                   E= [Enter Application E Here]
    C=   [Enter Application C Here]                                   F= [Enter Application F Here]

    ID      DESCRIPTION                                         STATUS*    SOURCE
  *STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            AUTHORIZATIONS
   ART    1 Enable online, entry and updates to requests
            for authorization and precertification
            approval.
   ART    2 Tracks requests for approval to include:
            a. approvals actually received
            b. Status of the approval
            c. Actual encounters charged against an
            approval
            d. Effective dates of the approval
            e. Other (Please specify)
   ART    3 Produces provider and client notification of
            the status of approvals, pending or rejected;
            and precertifications.
   ART    4 Able to receive and generate the HIPAA
            ANSI X12 278 Health Care Services Review
            EDI transaction.
   ART    5 Retrieve authorization information by:
            a. client ID
            b. Enrollee name
            c. Provider name
            d. Diagnosis
            e. Procedure
            f. Service
            g. Other
   ART    6 Provide free text fields on authorization
            screen using industry standard word
            processing functionality (e.g., paragraph
            formatting, cut-n-paste, fonts).
   ART    7 Generate form letters pertaining to
            authorizations.
   ART    8 Automatically assign unique ID number for
            each authorization.
   ART    9 Maintain separate accrued accounts for pre-
            authorized services.
   ART   10 Provide data on authorizations by
            episode/encounter.
   ART   11 Enable users to review data using client
            inpatient days, visits, referrals, and diagnosis.

   ART 12 Provide the following information for each
          client encounter, as applicable:
          a. Admission/visit date
          b. Discharge date
          c. Physician/Provider
          d. Estimated cost
  ID     DESCRIPTION                                      STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
         e. Hospital/Entity name
         f. Diagnosis
         g. DRG
         h. Length of stay
         i. Procedure/Service
         j. Program
ART 13   Provide by diagnosis the following information
         on referrals:
         a. Provider requesting referral
         b. Provider being referred to
ART 14   Calculate maximum approved amount for
         service to be provided (from rate table).
ART 15   Provide comparative information on actual
         utilization versus authorized amount.
ART 16   Generate reports on provider data and
         provider groups.
ART 17   Generate reports on referrals by provider and
         provider group.
         REFERRAL TRACKING
ART 18   Ability to enter a referral for specialist or
         ancillary treatment. Information included as
         part of the client‟s referral would be the
         provider or service referred to, time
         requirements, visit amounts and limitations,
         pre-authorization numbers, and authorizing
         persons and phone numbers.
ART 19   Integrates referral management efforts with
         the registration so that referral information
         can be attached to scheduled visits.
ART 20   Referral module/function is integrated with
         the Access Management and Client Contact
         module/function (See ACM) so that intake
         activities performed by the Department call
         center/gateway are integrated with
         subsequent client authorization and referral.

ART 21 Decrement authorized visit number when
       visits are scheduled and completed.
ART 22 Ability to track/report on referral, including
       who has outstanding referrals, referrals close
       to expiring, referrals by client service,
       providers with completed referrals, and
       referrals by third party payors.
ART 23 Tracks requests for referral and
       precertification approvals, approvals actually
       received, encounters charged against them
       and “balance” remaining.
ART 24 Produces provider and client notification of
       the status of approvals, pending or rejected
       and referrals.
ART 25 Referrals can be entered either manually or
       via electronic files/transactions.
ART 26 Multiple services are allowed per referral
       request.
  ID     DESCRIPTION                                    STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
ART 27 Supports multiple referral types such as
       inpatient, residential, IMD, and oupatient.
ART 28 Ability to track incoming referrals, outgoing
       referrals, as well as internal referrals.
ART 29 Referrals can be prioritized and monitored
       based upon that prioritization.
ART 30 Referrals can be required based upon user
       defined provider profiling as well as specific
       components within the benefit plan.
ART 31 Completed and scheduled visits will be
       associated and tracked against the
       appropriate referral.
ART 32 System can automatically associate a visit
       with an open referral based upon such
       factors as: provider, date, location.
ART 33 The scheduling staff can also override that
       association.
                            FORM A
           FUNCTIONAL REQUIREMENTS
              (ART) Authorization/Referral
                                 Tracking
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
VENDOR [Enter Vendor Name Here]
                                                                          FUNCTIONAL REQUIREMENTS
                                                                             (CPA) Claims Processing and
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                              Adjudication
  A=    [Enter Application A Here]                            D= [Enter Application D Here]
  B=    [Enter Application B Here]                            E= [Enter Application E Here]
  C=    [Enter Application C Here]                            F= [Enter Application F Here]

ID       DESCRIPTION                                    STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
CPA 1  Online entry/update of claims information.
CPA 2  Online search and retrieval of claims
       information by:
       a. Claimant name
       b. Claim number
       c. Patient account number
       d. Date of service
       e. Employer group
       f. Provider name
       g. Enrollee identification (ID) number
       h. Social security number
       i. Medical record number
       j. Short Doyle number
CPA 3  Accommodate user-defined data elements
       for claims screen.
CPA 4  Receive and process HIPAA ANSI X12N 837
       Health Care Claims and or Equivalent
       Encounter transactions.
CPA 5  Produce a suspended claims report.
CPA 6  Generate letters pertaining to claims in user-
       defined format.
CPA 7  Enable the professional formatting of the
       generated letter using industry standard
       formatting to include the following:
       a. Insert logos
       b. Print letterhead banner
       c. Paragraph formatting
       d. Fonts
       e. Color
CPA 8  Provide online search and retrieval of
       provider information.
CPA 9  Accommodate special screens which provide
       claims history.
CPA 10 Claims are screened with user override for:
       a. Valid Data (such as UPIN#)
       b. Member Coverage
       c. Valid Authorization
       d. Contract terms
CPA 11 Online edit and notification for duplicate
       claims made for the same enrollee based
       upon user defined data elements but to
       include at least the following:
       a. Date
       b. Provider
       c. Services
ID       DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
CPA 12 Online system checks or reminders to
       ensure validity of claims data being entered.

CPA 13 Verify eligibility before claims acceptance.
CPA 14 Automatic benefit level determination for
       claims processing.
CPA 15
       Automatic percent of responsibility
       determination for claims processing based
       on financial eligibility and covered services.
CPA 16 Automatic calculation of the following:
       a. Deductibles
       b. Copayments
       c. Disallowed adjustments
       d. Contracted amount
CPA 17 Allow editing of incorrect and erroneous
       claims information online.
CPA 18
       System can model California MediCal rules
       for greater claims editing functionality.
CPA 19
       Track all stop loss or applicable coinsurance.
CPA 20 Maintain user-defined limits/cutoffs on:
       a. Visits
       b. Copayments
       c. Deductibles
       d. Service
CPA 21 Provide ability to alter fee schedules for
       special services or procedures.
CPA 22 Itemize claims that have already been
       processed, including:
       a. Deductibles
       b. Copayments
       c. Date of service
CPA 23 Maintains separate encounter and claim
       adjudication programs that allow users to
       enter data without adjudicating claims.
CPA 24 Users can define when adjudication process
       occurs based on at least the following criteria
       being met:
       a. Valid claims criteria
       b. Copays met
       c. Deductibles met
       d. Out of pocket maximums met
       e. Authorization
       f. Eligibility verification
CPA 25 Perform fund management to include
       Medicare, HMOs, PPOs, MediCal, Private
       Pay, Managed Fee-for-Service, Indemnity
       plans, and others.
CPA 26 Automatic adjustment of fund balances due
       to claims reversals.
CPA 27 Protect and override systems defaults of
       claims information.
ID        DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
CPA 28 Track claims from time of receipt until
       completion of processing/ payment.
CPA 29 Accommodate multiple reimbursement
       methodologies including:
       a. Fee-for-service
       b. Capitation
       c. Discounted fee-for-service
       d. Fee schedule (multiple)
       e. Per diem (multiple levels)
       f. Percent of charges
       g. DRGs
       h. Individual contracts
       i. Multiple Case Rates
       j. Global/per diem fees
       k. Relative value
       l. Custom pricing formulas (e.g., Lesser of
       flat rate or percent of charges)
CPA 30 Detailed itemization of provider data
       including:
       a. Contractual arrangement
       b. Withholding percentage
       c. Discount percentage per member per
       month costs
CPA 31 Generate claims information and reports by
       provider, provider groups, programs, and
       specialty.
CPA 32 Generate reports for each enrollee that show
       comprehensive and itemized claims
       information.
CPA 33 Generate reports on rejected claims with
       reasons by provider.
CPA 34 Generate remittance advice
CPA 35 Generate California State required billing file.
       Demonstration of California state experience
       will be a key evaluation factor.
CPA 36 Able to receive and process California State
       Explanation of Benfits (EOB) file.
CPA 37 Able to generate HIPAA ANSI X12N 835
       Remittance Advice EDI transactions.
CPA 38
       Generate reports based upon the following:
       a. Erroneous claims
       b. Incomplete claims
       c. Reason codes
CPA 39 Generate reports on claim approvals.
CPA 40 Generate reports on rejected claims.
CPA 41 Generate reports on outstanding/ pending
       claims and claims placed on hold.
CPA 42 Generate transaction reports on claims
       processing.
CPA 43 Generate control reports for internal
       management purposes.
CPA 44 Accept UB-92, and HCFA 1500, HCFA 1450
       forms electronically from provider systems
       through October 2002.
ID       DESCRIPTION                                  STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
CPA 45 Generate IBNR (Incurred But Not Reported)
       Liability Report based on authorized but not
       yet incurred services and reconcile against
       billings.
CPA 46 Estimate outstanding claims utilizing
       payment log analysis.
CPA 47 Report paid claims data individually and
       combine paid/outstanding claims.
CPA 48 Download information to a PC for
       independent processing.
                              FORM A
       FUNCTIONAL REQUIREMENTS
          (CPA) Claims Processing and
                          Adjudication
nter Application D Here]
nter Application E Here]
nter Application F Here]

            COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
VENDOR [Enter Vendor Name Here]
                                                                                         FUNCTIONAL REQUIREMENTS
                                                                                  (CMN) Provider Contract Management
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                              and Negotiation Support
     A=   [Enter Application A Here]                                      D= [Enter Application D Here]
     B=   [Enter Application B Here]                                      E= [Enter Application E Here]
     C=   [Enter Application C Here]                                      F= [Enter Application F Here]

ID        DESCRIPTION                                               STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          CONTRACTING
          The system should have the ability to support the
 CMN 1
          following provider payment methods:
          a. Discount from charges (variable by revenue code,
          CPT-4 code or ICD-9-CM code)
          b. Simple and multitiered per diem defined by
          room/bed of patient, and/or service lines.
          c. Per case/episode
          d. Fee-for-Service
          e. Per Member Per Month
          The system should allow the user to define
 CMN 2    groupings of providers for modeling or reporting
          purposes.
          The system should allow the user to perform "what
          if" analysis of potential new rates, new payment
          methods, or changes to provider utilization patterns.
 CMN 3
          These new parameters should be processed
          against the actual patient mix for that contract over a
          specified period.
          The system should allow calculation of expected
 CMN 4    gross payments based on past patient mix,
          utilziation patterns, but at variable volume levels.
          Standard monthly (and on demand) reports should
          be provided which summarize all utilization activity
          for a specified period. Information should include
 CMN 5    provider name/number, volume, approvals, denials,
          charges, medical/loss ratio. Activity should be
          shown in total and also by program

          The system should automatically generate a
          renewal calendar showing key dates for each
 CMN 6    provider contract, including expiration date,
          cancellation notification date, and a user defined
          date to initiate renegotiation.
       The system should accept cost accounting
       information at the procedure level by product line,
CMN 7 provider group, department, individual charge code,
       split by fixed and variable component for each. This
       cost information should be used to produce analysis
       reports of contract medical/loss ratios.
       The system should store data linked to specific
       contracts, providers, and revenue
CMN 8 sources/sponsors. The system should then allow
       the use of this data to monitor that contracts
       performance.
       A modeling database should be part of the system
CMN 9
       for "what if" analysis.
       The system shall have the ability to estimate the
CMN 9
       impact of mix changes on medical costs.
       The user may define product lines and service units
CMN 10
       for analysis and reporting.
       The product lines or service units may be changed
CMN 11
       by the user after initial start-up.
       The system will maintain the following information
CMN 12
       for each provider contract:
       a. Name, address, contact persons, and phone
       number of plan
       b. Contract persons and phone numbers (at least
       two)
       c. Other names of the plan
       d. Term of the contract (start/end dates; multiple
       start/end dates for same contract)
       e. Renewal provisions (i.e., automatic or on notice of
       intent and length of notice period)
       f. Provider/Program code
       g. Precertification organization, address, and phone
       number
       h. Precertification requirements
       i. Provider address and phone number
       j. Billing address and phone number

       k. Payment method type and parameters by patient
       type (including but not limited to: percent of
       charges; single and multiple per diems; per case;
       pass through items; and stop loss clauses)
       l. Utilization Management criteria
       m. Payment timeliness requirements
       n. Type of contract
       o. Coordination of benefits information
       p. Payment denial rules
       The system stores a minimum of 999 different
CMN 13
       contracts.
       Historical contract data, such as volumes, revenues,
CMN 14
       medical loss, claim rejections and remittance
       history, can be maintained and reported on.
       Rates and formulas should be maintainable by end
CMN 15
       users, not programmers.

         Contract terms and conditions including covered
CMN 16
         and noncovered sources and UM requirements
         should be available online to all with a need to know.
         CONTRACT MODELING AND ADMINISTRATION

         Simulate unlimited contract rate variations ranging
CMN 17
         from simple discounts to full risk capitation with any
         combination of rate and terms.

CMN 18 Provide modeling to the line item level to determine
       effects of stop losses, passthroughs, etc.
       Evaluate stop losses, co-insurance, passthroughs,
CMN 19 volume discounts, per diems, percentages,
       maximums, minimums, etc.
       Model multiple stop loss mechanisms for all
CMN 20
       contracts.
CMN 21 Passthrough high cost line items.
       Handle rebundled reimbursement for Laboratory,
CMN 22
       pharmacy, etc.
       Unbundle specific clinical services in price
CMN 23
       negotiations.
       Compare different rates by services provided across
CMN 24
       contracts and to regional averages.
       Provide comparative pricing data regional and state
CMN 25 highs, lows, and averages for high volume (or any)
       procedures.
       Provide summary of significant contract terms for
CMN 26
       administrative approval.
       Track and report contract action dates, contact
CMN 27
       names, phone numbers, and renewal dates.
       The system shall be able to model the impact of
CMN 28
       volume changes by:
       a. Service type
       b. Payor/Contract
       c. Program
       d. Provider
       Provide features to manage full-risk capitation
CMN 29
       plans.
         COST ANALYSIS
       Ranked management reports based upon contract
CMN 30
       volume, costs, and medical loss ratios.
CMN 31 Detailed reports of costs at product line level.
         Determine contribution margins by program and
CMN 32
         service type.
         Utilize cost accounting features to calculate actual
CMN 33
         product line cost (See CAM).
         Pinpoint provider panels and other areas of
CMN 34
         significant loss/risk.
         Provide standard measurements for performance
CMN 35   evaluation of contracts, providers, client sponsors,
         and insurance product lines.
         Produce hard profit/loss data by client sponsor,
CMN 36   provider, provider group/program, insurance product
         line, and market area.
         Provide for long-term storage for profitability
CMN 37
         analysis, marketing, and planning.
         Interface with cost accounting system to monitor
CMN 38   actual medical loss ration of each provider contract
         on inpatient and outpatient activity.
         UTILIZATION ANALYSIS
         Provide features to analyze utilization across
CMN 39
         contracts.
         Compare actual utilization to capitated actuarial
CMN 40
         projections.
         Average utilization profiles by charge code for
         specific clinical service by provider specialty,
CMN 41
         individual provider, program, and prepare variance
         analyses.
CMN 42   Provide ability to monitor appeal activity.
CMN 43   Provide ability to calculate appeal/denial ratio.
                          FORM A
         FUNCTIONAL REQUIREMENTS
  (CMN) Provider Contract Management
              and Negotiation Support
nter Application D Here]
nter Application E Here]
nter Application F Here]

              COMMENTS
W=WON'T BID
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                       (PRM) Provider Relations
  A=       [Enter Application A Here]                               D= [Enter Application D Here]
  B=       [Enter Application B Here]                               E= [Enter Application E Here]
  C=       [Enter Application C Here]                               F= [Enter Application F Here]


 ID                    DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID

           GENERAL FUNCTIONS
PRM 1      Ability to create and maintain a profile, or
           record, of each county and contracted
           provider. The provider file defines the
           agreed upon terms between the Agency
           and the provider regarding the provision of
           services to Agency clients.
 PRM 2     Allow provider relations coordinator to
           include extensive user-defined detailed
           information to document items including:
           a. Contact name
           b. Contact phone number
           c. Credentialing
           d. Agreed upon services
           e. Associated fees [including start and end
           dates]
           f. Eligible physicians/providers
           g. Reference information
           h. Account status
           i. Fax number
           j. Language
 PRM 3     Provide the cabilities for SCVHHS to
           credential its provider network.
           Functionality and data tracked should
           include:
           a. Tracking state board and licensure
           information
           b. DEA number
           c. Malpractice insurance
           d. Track required documents such as
           medical, narcotic, and controlled substance
           licenses.
           e. Track malpractice claims, suspensions,
           denial of license, and disciplinary actions

           f. Document education, CEUs, residencies,
           and fellowships
           g. Detailed privileges
           h. Track staff competencies.
 PRM 4     Ability for schedulers to access/view
           provider information in order to determine if
           the provider is capable of servicing the
           specified client.




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR      [Enter Vendor Name Here]                                                                  FORM A
                                                                                     FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                          (PRM) Provider Relations
  A=        [Enter Application A Here]                                 D= [Enter Application D Here]
  B=        [Enter Application B Here]                                 E= [Enter Application E Here]
  C=        [Enter Application C Here]                                 F= [Enter Application F Here]


 ID                       DESCRIPTION                           STATUS*      SOURCE            COMMENTS
                                                                        (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 PRM 5      Allow for automatic processing of a
            provider‟s fees when Agency bills a
            client/client for an exam/service, with cross-
            reference of referral billings.
 PRM 6      Allow adequate security/access to fee
            schedules for entry, maintenance, and
            updates by:
            a. Location
            b. Department
            c. User
 PRM 7      Produce client/client bill based on
            predetermined fees, by provider.
 PRM 8      List allowable procedures by provider and
            whether they are performed at providers
            site, or an alternate location by a third
            party/affiliated provider. System should
            indicate if provider/third party has own
            preparation instructions.
 PRM 9      Ability to track services charged/owed by
            each provider as well as referral provider.

 PRM 10     Ability to link third party referral providers to
            a network provider, who perform specific
            procedures in conjunction with services
            performed by an Agency network provider.

 PRM 11     Ability to store multiple contracts per
            provider (i.e., prior contract, current
            contract, future contract) in order refer to
            old fees no longer in effect, or future fees
            not yet in effect.
 PRM 12     Accommodate online entry of free text data
            against given services or selected provider
            files. Allow data entry of up to 500
            characters of each text segment.
 PRM 13     Automatically assign and record:
            a. Date the record was entered into the
            system
            b. Date the record was changed
            c. Identification of person entering or
            changing the record
            d. Identify changes made




                                      ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR      [Enter Vendor Name Here]                                                                FORM A
                                                                                   FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                        (PRM) Provider Relations
  A=        [Enter Application A Here]                               D= [Enter Application D Here]
  B=        [Enter Application B Here]                               E= [Enter Application E Here]
  C=        [Enter Application C Here]                               F= [Enter Application F Here]


 ID                      DESCRIPTION                        STATUS*        SOURCE            COMMENTS
                                                                        (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 PRM 14     Provider profile information (e.g., fees per
            exam type) is automatically entered into a
            clients file when an exam is scheduled
            using that provider‟s number.
                        PROVIDER DATABASE
 PRM 15     Ability to enter/store the following
            demographic data elements for each
            provider:
            a. First, middle, and last name or business
            b. Provider number
            c. Social Security number
            d. Date of birth
            e. Sex
            f. Citizenship
            g. Languages spoken (up to 3 languages)

            h. Fax number
            i. Office address(es) (up to three locations)

            j. Office telephone number(es) (Up to three
            locations)
            k. Department
            l. Scheduling Contact
            m. Provider Relations Contact
            n. Specialty
            o. Subspecialty
            p. Cultural competency (e.g., Vietnamese)
            (Up to 3 competencies)
            q. Contact for outstanding report
            r. Office hours
            s. Full time/Part time
            t. Per diem
            u. Allowable exam types
            v. Fees by procedure/charge code (see
            PAM)
            w. Travel directions
            x. Special instructions
            y. Email address
 PRM 16     System prevents display of subsequent
            provider registration screens until all
            mandatory data has been entered or a
            suitable exception code has been entered.
            Users with appropriate security clearance
            have override capability.


                                    ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR      [Enter Vendor Name Here]                                                                  FORM A
                                                                                     FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                          (PRM) Provider Relations
  A=        [Enter Application A Here]                                 D= [Enter Application D Here]
  B=        [Enter Application B Here]                                 E= [Enter Application E Here]
  C=        [Enter Application C Here]                                 F= [Enter Application F Here]


 ID                      DESCRIPTION                          STATUS*        SOURCE            COMMENTS
                                                                        (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 PRM 17     Support the following provider education
            and training data elements (this should be
            available for each member of the practice):

            a. Educational institution
            b. Type of educational institution (e.g.,
            medical school, nursing school)
            c. Foreign Medical Graduate (FMG)
            number
            d. Professional certifications (including
            boards)
            e. Year certified
            f. Year recertification required
 PRM 18     Support the following password protected
            licensure data elements:
            a. State license number and expiration date

            b. Medicare license number and expiration
            date
            c. DEA number and expiration date
            d. UPIN number
            e. Other license number and expiration
            date
 PRM 19     Support the following affiliation data
            elements:
            a. Name of institution
            b. Institution address
            c. Type of institution (e.g., residential care,
            hospital, etc.)
            d. Year appointed
            e. Rank/title
            f. Admitting privileges (Yes/No)
            g. Curtailment or restriction of affiliation
            privileges
            h. Professional societies
 PRM 20     Support the following professional liability
            data elements:
            a. Insurance company name
            b. Insurance company address
            c. Amount of liability coverage
            d. Policy number
            e. Data of liability coverage expiration
            f. Insurance certificate on file
            g. Primary insurance company indicator



                                      ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR      [Enter Vendor Name Here]                                                                 FORM A
                                                                                    FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                         (PRM) Provider Relations
  A=        [Enter Application A Here]                                D= [Enter Application D Here]
  B=        [Enter Application B Here]                                E= [Enter Application E Here]
  C=        [Enter Application C Here]                                F= [Enter Application F Here]


 ID                      DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                        (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
            h. Rating
 PRM 21     Support the following group practice and
            managed care data elements:
            a. Name of group practice
            b. Group practice address
            c. Group practice phone number
            d. Managed care organization name
            e. Managed care address
            f. Managed care phone number
 PRM 22     Support the following correspondence-
            related data elements:
            a. Corresponding party
            b. Date correspondence received
            c. Nature of request
            d. Response date
 PRM 23     Ability to search provider file using the data
            in any one field, or combination of fields
            (e.g., search for a provider when only
            known information is provider phone
            number, and name).
 PRM 24     Ability to search any field within the
            provider file and run reports using multiple
            provider criteria.
                     PROVIDER MAINTENANCE
 PRM 25     Ability to store/track/maintain the following
            Provider Agreement elements:
            a. Agreed upon services to be provided
            b. Agreed upon fee schedule by provider
            c. Agreement date limits
            d. Terms of agreement
 PRM 26     The provider database differentiates
            between specific provider types (physician,
            psychologist, therapist, etc.)
 PRM 27     Provide a unique provider code number to
            each provider. Code numbers should be a
            user-defined number of characters.
 PRM 28     Referred vendors associated with a
            particular provider should link to the
            provider/provider code number, if not the
            same number.
              AGREEMENT/AGREEMENT RENEWAL
 PRM 29     Generate a user -designed
            agreement/agreement renewal form,
            including information such as:



                                     ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR      [Enter Vendor Name Here]                                                                 FORM A
                                                                                    FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                         (PRM) Provider Relations
  A=        [Enter Application A Here]                                D= [Enter Application D Here]
  B=        [Enter Application B Here]                                E= [Enter Application E Here]
  C=        [Enter Application C Here]                                F= [Enter Application F Here]


 ID                      DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                        (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
            a. Number of client encounters per year for
            the previous four years
            b. Number of client encounters year-to-
            date
            c. Consultations performed and referred
            d. Current restrictions on service provision

 PRM 30     Provide several options for generation of
            the agreement/ agreement renewal form
            including sorting by:
            a. Specific provider
            b. Program
            c. Specialty
PRM 31      Generate user-designed letters to send to
            other facilities to gather information on
            provider appointments and
            reappointments.
 PRM 32     Generate user-designed reports on
            provider agreements and agreement
            renewals to submit to the Agency.
                          MISCELLANEOUS
 PRM 33     Provide tables for fields with multiple
            acceptable values (i.e., allow user to set
            predefined values for a field limiting user to
            select from a list of acceptable values).

 PRM 34     Provide a user-friendly table maintenance
            function.
 PRM 35     Provide online help for each field in the
            database.
 PRM 36     User interface permits viewing of multiple
            screens simultaneously, within a single
            provider file and between providers.
 PRM 37     Provide infinite search capabilities on all
            demographic fields.
 PRM 38     Provide an online tickler file for automatic
            clerical follow-up of incomplete data or
            responses.
 PRM 39     From any field for which table values exist,
            allow table to be directly accessed via a
            function key, select a value, and return to
            the field.
 PRM 40     Allow automatic updating of all files, as
            necessary.



                                     ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR      [Enter Vendor Name Here]                                                                FORM A
                                                                                   FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                        (PRM) Provider Relations
  A=        [Enter Application A Here]                               D= [Enter Application D Here]
  B=        [Enter Application B Here]                               E= [Enter Application E Here]
  C=        [Enter Application C Here]                               F= [Enter Application F Here]


 ID                      DESCRIPTION                        STATUS*        SOURCE            COMMENTS
                                                                        (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
                 PROVIDER DATA INTEGRATION/
                                ACCESS
PRM 41      Allow multi-level security access to provider
            information by code number, name, or
            license number.
 PRM 42     Allow access to pertinent provider data
            from any terminal given appropriate
            password security clearance. Specifically
            provide access from/to:
            a. Scheduling
            b. Sales
            c. Provider Relations
            d. Accounting
            e. Report Processing
PRM 43      Departments should have inquiry access to
            items such as contract information,
            provider capabilities, special comments.
 PRM 44     Provide mapping/geographical query
            module which includes the following
            features:
            a. List and visually indicate location of all
            providers within a user-defined radius (e.g.
            50 miles, of a given address).
            b. Allow zooming of geographical maps to
            street level.
            c. Provide online routing information
            between two given locations.
 PRM 45     Automatically update mapping software
            with geographical provider information so
            that it can be easily viewed.
 PRM 46     Ability for user to define certain fields as
            required or optional. If required, system
            will not allow user to move to next screen.

 PRM 47     Allow authorized users to have override
            capability.
 PRM 48     Allow inquiry only access to provider file by
            all departments, based on assigned
            security level.
 PRM 49     Allow inquiry and modification access to
            provider file by specific staff based on
            assigned security level.




                                    ce889d78-b37a-40aa-911d-6676ae69d824.xls/PRM
VENDOR     [Enter Vendor Name Here]
                                                                           FUNCTIONAL REQUIREMENTS
                                                                       (ACM) Access Management - Client
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                              Contact
   A=      [Enter Application A Here]                           D= [Enter Application D Here]
   B=      [Enter Application B Here]                           E= [Enter Application E Here]
   C=      [Enter Application C Here]                           F= [Enter Application F Here]


 ID                     DESCRIPTION                        STATUS*   SOURCE
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID

           CLIENT CONTACTS
 ACM 1     Integration with Master Patient Index
           module to allow operator to quickly and
           easily locate and pull up existing client
           information.
 ACM 2     Integration with Online Eligibiliy module to
           verify client's enrollment in a Department or
           other health plan.
 ACM 3     Integration with Authorization and Referral
           module to allow the operator to authorize
           services to the client as deemed
           appropriate.
 ACM 4     If a new client, integrate with the
           Preregistration Module to collect pertinent
           client information.
 ACM 5     Provide the operator a library of standard
           contact scripts for standard coding.
 ACM 6     All client specific information is
           automatically brought forward into the
           script.
 ACM 7     Contact information is automatically
           recorded including:
           a. Operator ID
           b. Date and Time of call
           c. Duration of call
 ACM 8     Maintenance and access to clinician On-
           Call schedule.
           REFERRAL / APPOINTMENT
           SCHEDULING
 ACM 9     Intergration with the Resource Scheduling
           module so the operator can see all
           available time slots for all Programs.

 ACM 10    Integration with the PRE preregistration
           function to collect required client
           information.
 ACM 11    Enable the recording of the level of care
           sought, the level of care referred to, and
           the level of care accepted.
ACM 12   Appointments made by operators are given
         a special status and flag so that Program
         staff can followup with the client to confirm
         the appointment.
ACM 13   Operators can be assigned varying levels
         of security to see only certain program
         schedules, and to schedule appointments.

ACM 14   Allow operator to find first available time
         slots.
ACM 15   Allow operator to find the most appropriate
         program and/or provider based on a
         number or search parameters including:

         a. Cultural competency
         b. Nearest location to client based on zip
         code.
         c. Existing program assignment if client is
         an active client.
         d. Program/provider accepting new clients

         e. Previous program assignment if client
         was an active Department client.
ACM 16   Allow operator to find the most appropriate
         clinician based on a number or search
         parameters including:
         a. Cultural competency
         b. Availability
         c. Existing clinician assignment if client is
         an active client.
         d. Previous clinician assignment if client
         was an active Department client.
         CONTACT SCRIPTS
ACM 16   Enable the Department to create custom
         client contact scripts.
ACM 17   Enable an authorized user to 'copy' existing
         standard scripts for modification into a new
         script.
ACM 18   Enable flexible script flow based on client
         responses to questions.
ACM 19   Integrated work processing capabilities for
         documentation of the call.
ACM 20   Scripts are created using a graphical
         approach to design, no programming
         required.
ACM 21   Able to create standard response values
         that appear as pull down boxes during a
         client contact call.
ACM 22   Enable the design of database connection
         to any and all available data elements in
         the system so that data can be
         automatically brought forward into a script
         during a client contact.
ACM 23   Provide a standard set of scripts based on
         industry accepted behavioral health triage
         protocols. (Please specify)
ACM 24   The standard set of scripts can be modified
         to Department specifications.
ACM 25   At a minimum, allow the operator to record
         the following:
         a. Complaints (table driven)
         b. Symptoms (table driven)
         c. Problems (table driven)
         d. User defined coded responses
         d. Free form text
         CLIENT CONTACT REPORTS
ACM 26   At the end of the client contact call, a
         summary of the contact is automatically
         produced to include:
         a. Complaints
         b. Symptoms
         c. Problems
         d. Responses to script questions
         e. Followup items
         f. Pre-registration data
         g. Date/time of start and end of call
         h. Operator ID
         i. Visit schedule
ACM 27   Provide word processing capabilities to
         enable the operator to edit the client
         contact summary report.
ACM 28   Enable the operator to assign a responsible
         party for followup.
ACM 29   An assigned followup automatically
         generates a tickler list for the assigned
         responsible party.
ACM 30   An assigned followup automatically
         generates a tickler list for the assigned
         responsible party.
ACM 31   Followup assignment is structured and
         should include the following:
         a. Client call back reminder
         b. Date and time of followup
         c. Page clinician
         d. Schedule appointment
         e. Refer to Psychiatric ED
         f. Refer to other agency
ACM 32   Followups record the following information:
         a. Status of followup
         b. Priority of followup (emergent, non-
         emergent)
         c. Scheduled date and time
         d. Actual date and time
         e. Responsible party
ACM 33   Able to fax the client contact summary
         report to the appropriate parties via a fax
         server.
ACM 34   Produce a summary of client contacts
         based on user specified time period to
         include:
         a. Shift
         b. Day
         c. Week
         d. Month
ACM 35   client contacts reports can be organized in
         the following ways:
         a. By operator
         b. By call type
         c. By complaint / problem
         d. By followup status
         e. Other (specify)
         WORKFORCE MANAGEMENT
ACM 36   Maintain a operator staff database that
         records the following:
         a. Schedules
         b. Preferred shift
         c. Language competency
         d. Operator ID
                         FORM A
      FUNCTIONAL REQUIREMENTS
  (ACM) Access Management - Client
                         Contact
nter Application D Here]
nter Application E Here]
nter Application F Here]


                  COMMENTS
CUSTOM, W=WON'T, D=DIDN'T BID
Clinical Operations
VENDOR [Enter Vendor Name Here]
                                                                            FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                           (EMR) Electronic Medical Record

     A=   [Enter Application A Here]                            D= [Enter Application D Here]
     B=   [Enter Application B Here]                            E= [Enter Application E Here]
     C=   [Enter Application C Here]                            F= [Enter Application F Here]

ID        DESCRIPTION                                     STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          DATABASE STRUCTURE
EMR 1     Provide entity-relationship diagrams
          indicating relationships among tables,
          including primary and secondary keys.
EMR 2     System allows for change in dictionary as
          national or SCVHHS standards evolve.
EMR 3     Supports a master terminology index which
          designates a single, unambiguous standard
          term for each commonly used medical term,
          diagnosis, observation, intervention, etc.

EMR 4     Thesaurus translates acceptable
          abbreviations, synonyms, shorthand and
          common misspellings for the standard terms.

EMR 5     Application provides a configuration option
          that suggests standard terms whenever a
          non-standard term is used.
EMR 6     Provide lifetime patient record for all
          encounters including:
          a. Inpatient stay
          b. Outpatient encounter
          c. Short stay (inpatient stay under 24 hours)

          d. Clinic visit
          e. Home care
          f. Residential Care
          g. Outreach
          h. Emergency Department
          I. Urgent Care Center
          j. Call center contacts
EMR 7     Provide the user with the ability to set the
          parameters for retaining information based
          upon:
          a. Date of episode close
          b. Date of last system activity
          c. Episode type
EMR 8     Provide standardized coding of data
          elements to allow reporting and analysis
          using the following systems:
          a. SNOMED
          b. ICD 9-CM
          c. DSM
          d. Arden Syntax
          e. Proprietary
          f. Other (Please specify)
EMR 9     Allow an unlimited number of encounters per
          patient.
EMR 10    Allow an unlimited number of patients in the
          database.
EMR 11    Provides two separate databases: active
          database and archival
EMR 12    Provide extensive editing of data entered in
          the Electronic Medical Record to guarantee
          data quality:
          a. Standard editing
          b. User defined editing
EMR 13    Comply with the evolving standards for the
          Computer-Based Patient Record from the
          Institute of Medicine.
          DATA ACCESS
EMR 14 Provide views of the patient data based upon
       needs of the user:
       a. Clinician view
       b. Therapist view
       c. Pharmacist view
       d. Researcher view
       e. Student view
       f. Administrator view
       g. Financial view
       h. Quality Assurance view
       I. Medical Records view
EMR 15 Provide the ability to "flip through" the patient
       data in a manner similar to reviewing a paper
       chart.
EMR 16 Search for information by individual data
       elements e.g. if select allergies, screen where
       allergies documented would be listed.

EMR 17 Provide key data as defined by the user (e.g.,
       problem list, allergies) on a single screen.

EMR 18 Provide database access on a 24-hour per
       day, seven-day per week basis.
EMR 19 Provide access to patient data with three or
       less menu selections, including sign-on.
EMR 20 Provide access to patient data with standard
       microcomputer terminal.
EMR 21 Provide access to patient data from remote
       locations via a web-enabled user interface.
EMR 22 Provide graphical capabilities for viewing data
       trends.
         DATABASE LINKAGES
EMR 23 Provide linkages or real time interfaces to
       retrieve and store data from other internal
       and external systems using the following:
       a. Batch file loads
       b. Message Oriented Middleware
       c. Proprietary Interface Engine
       d. Industry Interface Engine
       e. Other (please specify)
EMR 24 Provide linkages or real time interfaces to
       retrieve and store data from the following
       external systems:
       a. Other providers' Electronic Medical
       Records
       b. Medline
       c. PDR
       c. Other (please specify)
EMR 25 Provide auto-fax capability to fax information
       to designated locations (e.g., pharmacies,
       other providers, adminsitration)

EMR 26 Provide ability to create correspondence and
       reporting requirements through online word
       processing templates:
       a. Pre-formatted chart documents
       c. Client follow-up instructions
       d. Consultation reports
       e. Reminder notices
       f. Dunning Letters
       g. Insurance forms
          DATABASE ANALYSIS AND REPORTING
EMR 26 Provide standard client reports which
       correspond to existing documents in the
       paper chart.
EMR 27 Allow users to customize any standard report.

EMR 28 Provide screen print capabilities of any
       screen, including screens with graphical
       displays.
EMR 29 Provide a user friendly ad hoc report writer
       which has the following capabilities:
       a. Using a mouse or light pen, "pick-and-
       point" any series of data elements for
       reporting purposes
       b. Graphical trending of any numeric data
       elements
c. Search within a patient record for ranges of
values and specific data elements (e.g.,
drugs, service type, etc.)
d. Search among multiple patient records for
ranges of values
e. Statistical capabilities (e.g., Std Dev,
Mean, time series)
                       FORM A
      FUNCTIONAL REQUIREMENTS

    (EMR) Electronic Medical Record

nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
TOM, W=WON'T BID
VENDOR [Enter Vendor Name Here]
                                                                                   FUNCTIONAL REQUIREMENTS
                                                                           (BHA ) Behavioral Health Assessment /
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                         Outcome Measurement
     A=       [Enter Application A Here]                               D= [Enter Application D Here]
     B=       [Enter Application B Here]                               E= [Enter Application E Here]
     C=       [Enter Application C Here]                               F= [Enter Application F Here]

ID            DESCRIPTION                                        STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
              ASSESSMENTS / SURVEYS
 BHA 1
              Each assessment provided below should
              contain items, both table driven (where
              appropriate) and text, that are considered
              standard in the Mental Health & Drug,
              Alcohol, and Substance Abuse Community.
 BHA 2
             Provide the ability to collect comprehensive
             diagnostic assessment information including:
             a. DSM diagnostic code (Tables for Axis I
             and Axis II diagnoses for each version of the
             DSM).
             b. An unlimited number of Axis I, II, III, IV,
             and V diagnoses.
             c. Effective dates for each Axis especially to
             delineate Past Year and Past Month
             diagnostic coding.
 BHA      3 Provide ability to automatically update DSM
             diagnostic codes when new codes are
             published.
 BHA      4 When diagnoses are made for client, system
             must keep track of the version that was in
             use at the time.
 BHA      5 When old records containing DSM diagnoses
             are viewed or printed, the system must
             search the DSM version that was in use at
             the time of diagnosis to retrieve the correct
             diagnoses.
 BHA      6 System should allow, but not require, entry of
             ICD codes for Axis III diagnoses, with option
             for table driven picklist.
 BHA      7 Axis IV and V should be table driven with
             optional text for Axis V.
 BHA      8 System should have "cross-walk" to ICD
             diagnoses.
 BHA      9 Allow authorized user to determine which
             relevant items collected at a prior point, either
             during referral, admission or a prior episode
             of care, can be carried over to Behavioral
             Health Assessments.
 BHA      10 Allow authorized user to determine which
             Behavioral Health Assessment items can
             appear on user screens on a program by
             program basis.
ID        DESCRIPTION                                    STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 BHA 11
          Provide means to track medications ordered
          from physicians outside of system in format
          that matches internally ordered medications.
 BHA 12
          Please indicate which assessment, outcome
          measurement tools and methodologies come
          'out-of-the-box' with the proposed system
          a. BASIS-32
          b. CAFAS - Child/Adolescent Functional
          Assessment Scale
          c. FAS - Functional Assessment Scale

        d. CSQ 8 - Client Satisfaction Questionnaire
        e. GAIN S9
        f. SF-12
        g. SF-36
        h. Devereux Scale
        I. ASAM PPC IIR (six dimensions)
        j.Other (please specify)
        k. Other (please specify)
        l. Other (please specify)
 BHA 13 Enable the design and implementation of
        custom assessment and questionnaire tools
        as determined by SCVHHS. Functionality to
        include the following:

          a. Upload tool designs from Microsoft Word
          b. Value pull-down lists
          c. Radio buttons
          d. Yes/No check boxes

        e. Flexible editing logic to verify responses.
        For example, If question1="yes" AND
        question2 =NULL then Error Condition
        f. Integration to the user customizable data
        model to capture the responses
        g. Scoring capabilities to build T-scores,
        percentiles, and other mathematical
        algorithms against the responses.
        h. Customizable online help to guide the
        client in filling out the assessment/survey
        I. Logical handling of missing values as
        specified by the user such as set to zero,
        treat as null, etc.
 BHA 14 All assessments can be printed out for the
        client to fill out.
 BHA 15 Provide form scanning capabilities to
        automatically read in filled out forms.
 BHA 16 Forms can be automatically faxed via a fax
        server.
          MENTAL HEALTH ASSESSMENTS
ID        DESCRIPTION                                        STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 BHA 17 Provide the ability to display and maintain
        Behavioral Health Assessment information
        including:
        a. Date of assessment.
        b. Time of assessment.
        c. Five Axis DSM diagnosis
        d. Chief complaint(s)
        e. Treatment team (Multiple, Table driven).
        f. Goals of treatment (associated with each
        problem).
        g. Measurable objectives of treatment
        (associated with each goal).
        h. Treatment interventions.
        i. Drug and alcohol (Y/N and unlimited free
        text).

          j. If drug or alchohol problem, allow option of
          hot key to Substance Abuse Assessment.
          k. Suicide risk (Table driven and associated
          text comment).

          l. If suicide risk, provide a "hot-key" that
          displays. previous assessments having to do
          with suicidality and previous notes of suicidal.
          ideation or behavior that are in system.

          m. History of suicidal ideation or behavior. If
          suicidal ideation, provide a "hot key" that
          displays previous assessments having to do
          with suicidality and previous notes of suicidal
          ideation or behavior that are in system.
          n. Risk of aggression (Table driven and
          associated comment).

          o. If risk of aggression is indicated, provide a
          "hot-key" that displays previous assessments
          having to do with aggression and previous
          notes of aggression or aggression control.
          p. Risk of homicide.

        q. Risk of elopement. If a risk of elopment is
        indicated, provides a "hot-key" to display any
        notes of elopement current or past episodes.
        r. Necessity of care
        s. Functional disabilities
        t. Social Functioning assessment
        u. Family Functioning assessment
        v. Vocational Functioning assessment
        w. Client hobbies
        x. Mental health related legal problems
 BHA 18 Allow authorized user to retrieve and display
        current and past medications
ID        DESCRIPTION                                    STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 BHA 19 Provide means to indicate persons or
        disciplines responsible for assessment and
        automatically mail notice of required
        assessment to person or office responsible
        for assessment.
 BHA 20
        Client Assessments can explicitly be
        associated to an episode of care. That is,
        there will be multiple assessments for a
        single episode comprising many client visits.
 BHA 21 Client Assessments can implicitly be
        associated to an episode of care based on
        assessment date and episode begin/end
        dates.

          SUBSTANCE ABUSE ASSESSMENT

 BHA 22 Provide ability to maintain master table of
        substances abused and collect information
        on the following:
        a. Formal name of substance.
        b. Street names of substance.
        c. Class of substance.
 BHA 23
        Allow system to maintain and display client
        information on substance abuse including:
        a. Substances used currently or in past (table
        driven from master file).
        b. Substance abuse withdrawal history.
        c. Motivation to become drug/alcohol-free.
        d. Current/past attendance in 12 step or peer
        support programs.

        e. General psychological well-being/distress
        f. Social functioning
        g. Social support
        h. Family functioning
        I. Vocational functioning
        j. How long ago in months was the last period
        of voluntary abstinence.
        k. How many months ago did voluntary
        abstinence end.
        l. Six ASAM criteria and severity rankings
 BHA 24 For each substance identified maintain
        information on:
        a. Substance abuse problem ranking:
        Primary, secondary, tertiary, other rank
        b. Frequency of use.
        c. First time
        d. Last time used.
        e. Longest period of regular use.
        f. Recurrent substance use resulting in a
        failure to fulfill major obligations at work,
        school, or at home (Y/N).
        g. Recurrent substance use in situations in
        which it is physically hazardous (Y/N).
ID        DESCRIPTION                                       STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          h. Recurrent substance-related legal
          problems (Y/N).

          i. Continued substance use despite persistent
          or recurrent social or interpersonal problems
          caused or exacerbated by the effects of the
          substance (Y/N).

          j. Is tolerance for substance present (Y/N)?
          k. Are withdrawal symptoms for the
          substance present (Y/N)?
          l. Is substance taken in larger amounts or
          over a longer time period than was intended
          (Y/N)?
          m. Is there a persistent desire or
          unsuccessful effort to cut down or control
          substance abuse (Y/N)?

          n. Is a great deal of time spent in activities
          necessary to obtain the substance, use the
          substance or recover from it's effects (Y/N)?
          o. Are important social, occupational, or
          recreational activities given up or reduced
          because of substance use (Y/N)?
          p. Is the substance used despite knowledge
          of having a persistent or recurrent physical or
          psychological problem that is likely to have
          been caused or exacerbated by the
          substance (Y/N)?
          q. Present or past substance-abuse-induced
          disorders.




          r. Has professional help for substance abuse
          been sought (Y/N)?

          s. If professional help sought: nature of help.
          t. Has non professional help for substance
          abuse been sought (Y/N)?.
          u. If yes: nature of help.
          v. Route of administration.
          w. client's stated reason for use.
          x. Use primarily with others or alone.
        MISCELLANEOUS ASSESSMENTS
 BHA 25 Provide ability to capture and maintain
        speech and language assessments.
ID        DESCRIPTION                                    STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 BHA 26 Provide ability to capture and maintain
        assessments of self care.
 BHA 27 Provide ability to capture and maintain
        information on assessment of cognitive
        functioning.
 BHA 28 Provide ability to capture and maintain
        information on abnormal involuntary
        movements assessments.
 BHA 29 Provide ability to capture and maintain
        nursing assessments (based on Hospital
        defined standards of care).
 BHA 30 Provide ability to capture and maintain
        information on assessments of educational
        functioning.
 BHA 31
        Provide ability to capture and maintain
        information on psychological assessments.
 BHA 32 Provide ability to capture and maintain
        information on neurological assessments.
 BHA 33 Provide ability to capture and maintain
        information on general physical health.
 BHA 34 Provide ability to capture and maintain
        information on rehabilitation readiness
        assessment.
          MISCELLANEOUS
 BHA 35 Assessments are integrated with the
        Behavioral Health Treatment Planning and
        Notes module (see BHT)
 BHA 36 Includes an assessment graphing tool to
        measure results over time. Graphing
        capabilities should include:
        a. Line plot
        b. Pie chart
        c. Histograms
        d. Mixed graph displays
 BHA 37 Assessments can automatically and flexibly
        be scheduled to include:
        a. Upon episode open
        b. Every six months
        a. Upon scheduled episode closing
 BHA 38 Assessments can be assigned to a
        responsible party
 BHA 39 Scheduled assessments result in the
        forwarding of the assessment to the identified
        responsible party in one or more of the
        following ways:
        a. via email alert
        b. assignment of the assessment on a
        system provided user 'to-do' or tickler list.

        d. Color coded annotations in the treatment
        plan highlighting scheduled assessments
 BHA 40 Assessment results can automatically
        recommend a diagnosis.
ID        DESCRIPTION                               STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 BHA 41 JCAHO approved ORYX data submission
        function
 BHA 42 Export capabilities to one or more of the
        following external file formats:
        a. Excel
        b. Text
        c. SAS
        d. Access
        e. SPSS
                       FORM A
      FUNCTIONAL REQUIREMENTS
BHA ) Behavioral Health Assessment /
             Outcome Measurement
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
          COMMENTS
TOM, W=WON'T BID
VENDOR [Enter Vendor Name Here]                                                                   FORM A
                                                                           FUNCTIONAL REQUIREMENTS
                                                                       (BHT) Behavioral Health Treatment
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
                                                                                           Plan and Notes
  A=     [Enter Application A Here]                             D= [Enter Application D Here]
  B=     [Enter Application B Here]                             E= [Enter Application E Here]
  C=     [Enter Application C Here]                             F= [Enter Application F Here]

ID       DESCRIPTION                                      STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
         TREATMENT PLANNING
BHT 1
         System maintains a central Multidisciplinary
         Treatment Plan with distinct sections that
         can each be modified independently by
         authorized users.
BHT 2    The system can incorporate client treament
         plan standards individualized by system of
         care, program, team, or individual clinician.

BHT 3    Based on the individual user, their
         preferred and individualized treatment plan
         library is presented to them.
BHT 4    The system allows for the creation,
         alteration or update of all standard
         treatment plans at anytime for a client.
         (Permanent changes performed only by
         authorized users)
BHT 5    Selection of treatment plans is integrated
         with individual client assessments.

BHT 6    Provide capability to meet all federal, state,
         and local regulations regarding the
         collection and reporting of Treatment
         Planning data.
BHT 7    Create individual client treatment plan from
         the selected library. Automatically include
         date and time created and clinician initials.

BHT 8  Provide mechanism for assigning
       responsibility for Treatment Plan section to
       specific staff or disciplines.
BHT 9 Provide mechanism for assigning
       responsibility to update specific section of
       treatment plan.
BHT 10 System keeps track of who is responsible
       for completing or updating which section of
       Treatment Plan and indicates date of
       completion or update.
BHT 11
       When Treatment Plan elements are also
       gathered automatically from other modules
       of the system (e.g., assessments, progress
       notes from previous episode, medications),
       data are shared with Treatment Plan and
       vice versa.
ID       DESCRIPTION                                     STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
BHT 12 System automatically flags Treatment
       Plans requiring review as specified by the
       user.
BHT 13
       Provide the ability to add a group
       intervention type (modality) to a Treatment
       Plan and automatically assign the client to
       the specific group and adds the group to
       the client schedule for the next six months.
BHT 14 Allow a client to be assigned to a group via
       the appointment scheduler with the system
       checking to see if the group is listed in the
       Treatment Plan.
BHT 15 If group is not in Treatment Plan, user is
       prompted to add it and provided with
       mechanism to do so immediately.
BHT 16
       System maintains a master file of problems
       including the following information:
       a. Problem code.
       b. Problem category (table driven).

       c. Problem description (unlimited free text).
       d. Multiple associated diagnosis.
BHT 17 Treatment Plan must include the following
       elements for viewing, printing, adding, or
       updating:
       a. Treatment team members.
       b. Five Axis DSM Diagnosis.

         c. Summary sections of all assessments
         gathered in Assessment Section.
         d. client problems
         e. Behavioral manifestations of problem.
         f. Problem status
         g. Problem treatment status
         h. Goals associated with each active
         problem.
         i. Measurable objectives associated with
         each goal.
         j. Treatment modalities/ interventions
         k. Current Medications.
         l. client participation in treatment planning
         process .
         m. client and/or family agreement with
         Treatment Plan.
         n. Discharge criteria related to client
         problems.

         o. Date of next scheduled review of
         Treatment Plan as determined by the user.
         p. Functional strengths.
         q. Barriers to treatment.
         r. Motivation for treatment.
         s. Contraindicated procedures.
ID       DESCRIPTION                                  STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
         t. Necessity of continued stay.
         u. Leave of absence (LOA) status (default
         to No).
         v. Reason for leave of absence.
         w. Expected date of return to treatment if
         on LOA.
         x. Continuing care plan including:




         unlimited free text).

         with each level of care or program
         identified in Discharge Plan.


       follow-up (Y/N).
BHT 18 Allow authorized users to add problems to
       problem list in following way:
       a. User designates problem to be entered
       as active or inactive

         b. When entering a problem, user selects
         problem category from user defined table.

         c. Once category is selected, category and
         program-specific picklist should appear.

       d. Once problem is selected, user should
       be able to customize problem wording.
       e. User is prompted to note behavioral
       manifestations of problem.
       f. User should be able to enter the problem
       severity.
       g. User indicates whether problem will be
       addressed by current treatment.
       h. User should be able to update the status
       or severity of a problem through the
       progress note or the Treatment Plan or
       Treatment Plan update.
BHT 19 System maintains, at a minimum, the
       following problems:
       a. Psychiatric Problems.
       b. Nursing Problems.
       c. Vocational Problems.
       d. Educational Problems.
       e. Medical Problems.
       f. Social Problems.
       g. Family Problems.
       h. Substance Abuse Problems.
       i. Housing Problems.
       j. Financial Problems.
ID       DESCRIPTION                                     STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
       k. Miscellaneous Problems.
BHT 20 System maintains a user defined table of
       offered interventions including, at a
       minimum:
       a. Individual Psychotherapy
       b. Psychiatric Rehabilitation Counseling
       c. Health Teaching
       d. Individual Psychoeducation
       e. Art Therapy
       f. Music Therapy
       g. Occupational Therapy
       h. Speech and Language Therapy
       i. Social Work Services
       j. Nursing Services
       k. Cognitive/Behavioral Therapy
       l. Case Management
       m. Home Visit
       n. Crisis Intervention
       o. Various assessments
       p. All groups offered by program
       q. Medication Management
       r. Psychological Testing
       s. ECT
       t. Group Therapy (See RES)
       u. Habitation services
       v. Substance abuse therapy/detox
       w. Educational Services
BHT 21 System maintains, for each offered
       intervention, by program, the following:
       a. Associated CPT code
       b. Associated charge code
       c. Associated charge
       d. Approximate cost
       e. Contracted cost
       f. Actual cost
       g. Associated note types (Multiple, related
       to table of notes)
       h. Intervention type
BHT 22 Identified interventions results in the
       forwarding of the intervention to the
       identified responsible party in one or more
       of the following ways:
       a. via email alert

         b. assignment of the intervention on a
         system provided user 'to-do' or tickler list.
         c. Forwarding to the appointment
         scheduling module.

       d. Color coded annotations in the treatment
       plan highlighting scheduled interventions
BHT 23 Display and print on demand updated
       treatment plan for inclusion in permanent
       medical record and historical care plan
       including all entries and modifications.
ID       DESCRIPTION                                  STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
BHT 24 The Departments are especially interested
       in coordinating the mental health and
       substance abuse therapies and
       interventions of dual-diagnosis clients.
       Does the proposed system enable the
       coordination of interventions and their
       planning between independent systems of
       care and Departments.
         TREATMENT / PROGRESS NOTES
BHT 25 System maintains different note categories
       including:
       a. Intervention notes (individual and group)
       which document interventions and
       correspond to different intervention types
       maintained in a MHD/DADS, program-
       specific table defined by MHD/DADS.
       b. Summary notes which document a
       particular area of client functioning or
       summarize response to different discipline-
       specific treatment efforts.
       c. Order-related notes which correspond to
       particular types of orders and are
       automatically generated by such orders.
       d. Incident notes which document the
       occurrence of particular incidents. (See
       INC)
       e. Non-billable indirect service notes which
       document special services performed but
       not billable.
BHT 26
       For each category of note the system
       maintains a set of note types each with
       unique formatting appropriate to note type.
BHT 27
       Support a group therapy notes type that
       displays all clients attending a group
       session as a single view, versus recalling
       each individual client one by one.
BHT 28 Progress note documentation is driven by
       the treatment plan so each treatment plan
       goal and intervention has associated
       progress notes.
BHT 29 Intervention notes are maintained in a
       MHD/DADS-defined, program specific
       table which includes, at a minimum:
       a. Individual Contact Notes including:



         Note

         was being taught clients and level of
         understanding
ID       DESCRIPTION                                  STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID




       b. Group service contact notes including
       notes for each specific group offered by the
       program as maintained in a Department
       defined table by authorized users.
       c. Collateral Visit Note providing a
       mechanism for indicating participants
       d. Family Therapy Note providing a
       mechanism for indicating participants
       e. Marital Therapy Note providing a
       mechanism for indicating participants
       f. Multiple Family Group Note
BHT 30 Allow online entry of medication history
       including:
       a. Allergies
       b. Medication orders
       c. Drug names
       d. Doses
       e. Dosage form
       f. Time(s)
       g. Dispensing Pharmacy
       h. Comments
BHT 31 Enable the interfacing of Methadone
       maintenance activity from M4 to the
       medication history documentation module

BHT 32 Able to document BHT.27 medication
       history via an interface from a pharmacy
       information system as specified by
       SCVHHS.
BHT 33 System allows each type of service note to
       be associated with an intervention from the
       Table of Interventions.
BHT 34 System maintains summary notes
       including, at a minimum, the following:
       a. Progress Notes including:

         objectives being addressed by note

         problems
ID       DESCRIPTION                             STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
         b. Shift Notes
         c. Financial Planning Note
         d. Social Work Summary Note
         e. Discharge Planning Note
         f. Milieu Note
         g. Treatment Plan Review Conference
         Note
         h. Team Conference Note including:



         for electronic signature
         i. Therapeutic Leave Outcome Note
         including:


BHT 35 System maintains order related notes
       including, at a minimum, the following:
       a. Admission note including:




         with BHT.41



         b. Discharge note including:




         driven)
         c. Therapeutic Leave Note including:




       d. Change in Status Note
       e. Medication Change Note
BHT 36 Non-billable Indirect Service Notes
       including, at a minimum, the following:
       a. Preparation
       b. Admitting Activity
       c. Telephone contact
       d. Report writing
       e. Phone contact
       f. Referral activity
       g. Information gathering
       h. Court testimony
ID        DESCRIPTION                                    STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
         i. Field service
         j. School visit
         k. Other indirect service
BHT   36 Allow users to enter new notes or append
         to existing notes at a later date with system
         tracking the time and date of entry or
         append.
BHT   37
         The format and template of the notes can
         be customized based on the type of note.
BHT   38 The system requires a separate step for
         permanently storing notes. That is,
         documentation remains draft until user
         performs a final store function.
BHT   39 Multiple warnings are required before
         information can be discarded.
BHT   40 System includes the following when an end-
         user makes a correction to a note:
         a. Original documentation
         b. Date and time of change
         c. Responsible party (names)
         d. Corrected documentation
BHT   41 System requires, for all corrections, a flag
         displaying that a correction exists.
BHT   42 Support downloads from a transcription
         system for inclusion of clinician‟s progress
         notes.
BHT   43 An unlimited number of user definable time
         period views of notes is supported. For
         example, today, current week, current
         month, etc.
BHT   44 The system allows for specific views to be
         identified via a person's sign on code as to
         get their view of choice once they signed
         on to the system.
BHT   45 Print on demand documentation for an
         individual client over a user-specified time
         period (e.g., today, week, month).
BHT   46 Print daily the previous 24-hour
         documentation by individual client for entire
         program to be included in permanent
         medical record.
BHT   47 Provide a pre-defined list of words/phrases
         for specified:
         a. Subtopics
         b. Diagnoses
         c. Interventions
         d. Procedures
         f. Findings Other
BHT   48 Provide Microsoft industry standard word
         processing functions including formatting,
         cut-n-paste, spell check, paragraph control,
         bullets, etc.
ID      DESCRIPTION                               STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
BHT 49 Seamless integration with Microsoft Word
       for creation and editing of notes using
       Microsoft templates.
VENDOR      [Enter Vendor Name Here]


APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES

  A=        [Enter Application A Here]                            D= [Enter Application D Here]
  B=        [Enter Application B Here]                            E= [Enter Application E Here]
  C=        [Enter Application C Here]                            F= [Enter Application F Here]

   ID       DESCRIPTION                                     STATUS*    SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
            ORDER ENTRY
 OEM
        1   Allow entry of Admission Order including:
            a. Date of admission/episode open
            b. Time of admission
            c. Admit from source
            d. Admit from ED
            e. Justification for admission
 OEM 2      Allow entry of Discharge Order including:
            a. Date of discharge / episode close
            b. Mental level upon discharge (Table
            driven)
            c. Condition of last visit (Table driven)
            d. Time of discharge
 OEM
     3      Allow entry of Special Precautions Order.
 OEM 4      Allow entry of Sharps Order.
 OEM 5      Allow entry of Aggression Control Order
            including:
            a. Type of control
            b. Justification for control
            c. Integrated with Incident Reporting
            module (see INC)
 OEM 6      Allow entry of Seclusion and Restraint
            Order. (see INC)
 OEM 7      Allow entry of Communication Restriction
            Order including:
            a. Restrict communication from (Table
            driven) and/or

            b. Restrict communication to (Table driven)
 OEM 8      Allow entry of Activity Restriction Order.
 OEM 9      Allow authorized users to change Status
            Order including entering information on:
            a. New status
            b. Justification for status change
 OEM 10
            Provide ability for order to be marked as
            "expected to be renewed", with prompts to
            clinician to renew order at appropriate time.
   ID     DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 OEM 11
          System has ability to "know" that orders
          expected to be renewed, which are
          associated with long acting medications
          (e.g., injectable neuroleptics given once a
          month), should appear as medications that
          the client is "on", even between orders.
 OEM 12   Upon attestation of medication order,
          create Medication Adjustment Note which
          indicates the order information and
          includes the reason for the medication
          change.
 OEM 13   When a medication is ordered that requires
          either one-time or ongoing associated
          bloodwork, the system should prompt
          users to automatically write the necessary
          orders and make the necessary
          appointments.
          ENTRY OF ORDER
 OEM 14   Provide a clinically oriented
          multidisciplinary order entry tool that
          streamlines the order entry process with
          the treatment plan.
 OEM 15   Identify physician/provider initiating order,
          staff entering order, date, and time. If the
          name of the individual entering the order
          and/or date and time are not put in at time
          of order entry, the system should
          automatically do so.
 OEM 16   User can locate clients by:
          a. Name
          b. Account number
          c. Medical record number / Short-Doyle
          d. Service/Program location
          e. Room number
 OEM 17   Allow selection of orders by service and
          subservice (e.g., Administration,
          Intervention, Laboratory, Pharmacy).
 OEM 18   Provide user-defined order sets and order
          panels with easy support for additions and
          deletions from these sets/panels.

 OEM 19   Provide a menu display of orders and order
          panels.
 OEM 20   Provide a system of mnemonics for test
          ordering.
 OEM 21   Provide selection of orders via:
          a. Alpha listing
          b. Procedure codes
          c. High-frequency menu listing
 OEM 22   Enable user to enter order priority to
          include:
          a. Routine
          b. STAT
          c. ASAP
   ID     DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          d. Today
          e. Timed
          f. Discharge
          g. Preadmission
 OEM 23   Allow user to designate start time and stop
          time for all timed and continuing orders.
          Authorized users must be able to override
          stop time for designated orders.

 OEM 24   Provide client schedules and department
          work lists based on orders placed.
 OEM 25   Allow entering of free text comments with
          order.
 OEM 26   Provide step-by-step ("Help") guide for
          Order Entry activities, returning the cursor
          to the place on the Order Entry screen at
          which the user left off.
 OEM 27   Display possible conflict of current order
          with previously entered orders including
          drug incompatibilities, based on user-
          specified criteria.
 OEM 28   Allow authorized individuals to override
          order conflicts, and maintain audit trail of
          these events.
 OEM 29   System automatically identifies and notifies
          user online of:
          a. Apparent duplicate orders.
          b. Improper order in scheduling sequential
          interventions.
 OEM 30   Indicate verification status of each order
          including when order was countersigned
          per provider policy.
 OEM 31   Provide system acknowledgment of
          acceptance of order.
 OEM 32   Enable user to communicate routine,
          standing, and selective preadmission
          orders on day of client's admission.
 OEM 33   Allow user to bypass menus when entering
          orders and directly key in desired order
          information.
 OEM 34   Provide an online narrative description of
          the use of each test, procedure, or
          interevention as well as any ordering
          policies and protocols affecting the ordering
          to assist the clinician when entering the
          order into the system.
 OEM 35   Identify and report specific procedures in
          the procedure master file which require
          verification prior to becoming active.
 OEM 36   Allow sensitive orderable items to be
          flagged as confidential.
 OEM 37   Permit inquiry into the exact status of all
          orders, by client (e.g., ordered, verified,
          canceled, preliminary report, or final
          report).
   ID     DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          EDITING ORDERS
 OEM 38   Provide automatic edit of all orders for
          necessary data which must be included at
          time of entry (e.g., route, dosage,
          assessment, treatment plan).
 OEM 39   Display message identifying missing data
          in the order.
 OEM 40   Provide order correction mechanism
          without requiring cancellation and re-
          entering of entire order, automatically
          recording date, time, and person entering
          correction.
 OEM 41   Permit only authorized personnel to cancel
          orders and automatically notify ancillary
          area of cancellation.
 OEM 42   When an order is held or canceled, provide
          the option to automatically cancel or not
          cancel charge based on cancellation code.

 OEM 43   Allow for backdating of order times and
          dates if system has been unavailable.
          Maintain actual date and time when orders
          are entered.
 OEM 44   Require client identification in client order
          (to avoid processing of order for client who
          is not in system).
          VERIFICATION
 OEM 45   Prompt user for verification, including the
          following:
          a. Completeness, such that all elements
          are included in order (e.g., route of
          administration, dose, time, frequency, and
          special instructions)
          b. Nurse or presumed ancillary personnel
          collection.
          c. Identification such that clients with same
          or similar names are accounted for in the
          system
          d. Provide for dual verification by
          authorized personnel (e.g.,
          physician/provider, pharmacist, etc).
          ORDER TRANSMITTAL
 OEM 46   Automatically print requisitions and labels
          in area of required service upon order entry
          for today's tests and on appropriate day for
          future orders.
 OEM 47   Automatically override print requisitions and
          labels into the area where the order was
          placed in the system instead of the client‟s
          registered location.
 OEM 48   Provide an audit trail of:
          a. Date and time an order was entered
          b. Date and time an order was received
          c. Time completed
   ID     DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          d. By whom completed
          e. The responsible party completing the
          order
 OEM 49   Flag STAT, ASAP, timed orders, or special
          instructions when the requisition prints.

 OEM 50   Provide option of visual or auditory alarm
          which requires a response on receipt of
          STAT, ASAP, timed orders, or special
          instructions.
 OEM 51   Explode orders, generating multiple orders
          from one request to all appropriate
          responsible parties.
 OEM 52   Explode cancellations to appropriate
          providers when original order is canceled.

 OEM 53   Display and print on demand an
          accumulated list of orders for a client for a
          designated time period.
 OEM 54   Provide information online on status of
          order processing.
 OEM 55   Flag canceled or held orders with a visual
          or audible alarm. If order is not canceled at
          the provider location, also notify the
          provider.
 OEM 56   Flag any changed order with a visual or
          audible alarm in the ancillary area.
 OEM 57   Retain record of order cancellation to
          identify who ordered the cancellation and
          when it was issued.
          SCHEDULING ORDERS
 OEM 58   Allow user to schedule one-time and
          continuing orders.
 OEM 59   Enable user to schedule a test or
          procedure at time order is entered. Notify
          provider (where test is scheduled) so that
          the time and date may be verified and
          provide automatic feedback of verification
          to the ordering area.
 OEM 60   Provide automatic scheduling of tests
          requiring more than one session for
          completion.
 OEM 61   Provide authorized individuals with the
          ability to override scheduling constraints in
          the system.
 OEM 62   Modify/update/correct/cancel scheduled
          procedure, allowing override of time slot
          previously assigned.
          CANCELLATION, RENEWAL,
          DISCONTINUANCE OF ORDERS
 OEM 63   Allow online cancellation, renewal,
          reschedule, and discontinuation of orders.
          If orders are canceled in error, there is a
          simplified way to reinstate them.
   ID     DESCRIPTION                                     STATUS*   SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 OEM 64   Automatically notify appropriate provider(s)
          online and in print of change(s) in order.

 OEM 65   Notify physician/provider online and in print
          of need for renewal before expiration of
          continuing order(s) per provider criteria,
          including:
          a. Name of client
          b. client ID number
          c. Name of service
          d. Beginning date and time of order
 OEM 66   Provide for automatic cancellation of orders
          upon discharge or death of a client.

          RETRIEVAL OF ORDER
 OEM 67   Display and print provider list of orders not
          completed.
 OEM 68   Display and print list of orders received,
          completed, canceled, postponed, held, or
          unreported, in chronological sequence by
          provider.
 OEM 69   Display and print on demand status of
          order (e.g., routine, ASAP, STAT,
          scheduled including start time and
          intervals).
 OEM 70   Display and print on demand orders for
          clients in the following manner:
          a. All orders for the current episode of care

          b. Outstanding orders
          c. Unverified orders
          d. Orders for last 24 hours
          MISCELLANEOUS
 OEM 71   Maintain audit trail logs of all activity.
 OEM 72   Generate charge description master with
          accompanying prices.
 OEM 73   Enable user to modify charge description
          master and prices as necessary.

 OEM 74   Provide option to display price on Order
          Entry screen.
 OEM 75   Documentation of orders is integrated with
          the Beahvioral Health Treatment Plan
          module (see BHT) so that appropriate
          identified interventions prompt an order
          entry screen.
 OEM 76   Orders automatically generate charges in
          the Patient Accounting Module.
 OEM 77   Posting of automatic charges can be
          determined by the user using the following
          parameters:
          a. at time of the order
          b. at time of verification
          c. at time of completion
                                  FORM A
                 FUNCTIONAL REQUIREMENTS

                (OEM) Order Entry Management

nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
           COMMENTS
STOM, W=WON'T BID
VENDOR     [Enter Vendor Name Here]                                                               FORM A
                                                                                 FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                         (CDS) CLINICAL DECISION SUPPORT
  A=       [Enter Application A Here]                               D= [Enter Application D Here]
  B=       [Enter Application B Here]                               E= [Enter Application E Here]
  C=       [Enter Application C Here]                               F= [Enter Application F Here]


 ID                    DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID

           RULES AND ALERTS
CDS 1      Interdisciplinary rules and alerts applied to
           repository using industry standard
           technology, which allows an organization to
           take advantage of rules developed at
           leading institutions (best practices).

CDS 2      Interdisciplinary rules and alerts applied to
           repository allow development of institution
           specific rules.
CDS 3      Allow integration of external rules
           databases such as Micromedix into the
           ordering process.
CDS 4      Provide suggestions for treatment,
           diagnosis, etc based on literature and
           user/clinician definition.
CDS 5      User can look up definition of diagnosis.
CDS 6      System recommends diagnosis based on
           assessment data entered.
CDS 7      User can look up definition of interventions.

CDS 8      Provides list of possible activities based on
           intervention selected.
CDS 9      Limit who has access to suggestions for
           treatment, diagnosis, etc based on security
           access code
CDS 10     Uses rules to interpret specific but varied
           client data points to determine if a reminder
           should be generated.
CDS 11     Provide ability to interface to third-party
           reference databases, (Medline, PDR, etc).

CDS 12     Issues an alert when order violates hospital
           policy.
CDS 13     Includes prompts to evaluate medications
           based on lab results.
CDS 14     Warns users of dangerous clinical states
           with access to incidents, outcomes, and
           assessment data.




                                  ce889d78-b37a-40aa-911d-6676ae69d824.xls/CDS
VENDOR     [Enter Vendor Name Here]                                                               FORM A
                                                                                 FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                         (CDS) CLINICAL DECISION SUPPORT
  A=       [Enter Application A Here]                               D= [Enter Application D Here]
  B=       [Enter Application B Here]                               E= [Enter Application E Here]
  C=       [Enter Application C Here]                               F= [Enter Application F Here]


 ID                     DESCRIPTION                        STATUS*        SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
CDS 15     Provides previous treatment plans which
           have proven most efficient and cost
           effective for a diagnosis when provisional
           diagnosis is entered for patient encounter.

CDS 16     Provides menu of recommended orders
           based on client‟s condition.
CDS 17     Recommends standard clinical pathway or
           protocol based on medical diagnoses
           entered.
CDS 18     Provide time based checks e.g. health
           screen intervals, assessments, drug
           monitoring ,etc.
CDS 19     Recommends preventive medical
           interventions.
CDS 20     Provides alert when length of stay for
           selected diagnosis is exceeded.
CDS 21     Identifies patients eligible for inclusion in
           studies.
CDS 22     Interfaces with institutional review board
           (IRB) database to notify clinicians when
           patient is on a research protocol/study.
CDS 23     Sends notification via email or electronic
           messaging (to researcher) when a
           specified event is triggered ( e.g.
           admission to hospital of previously enrolled
           research patient).
CDS 24     Sends notification via pager to researcher
           when patient who qualifies for research
           protocol is admitted.
CDS 25     Identifies if the research protocol is
           contractually approved (signed) grant or a
           contract.
CDS 26     Provides real time synchronous feedback
           to clinician upon signon
CDS 27     Asynchronous alerts and warnings to
           include paging, email, printed information
           and status displays
CDS 28     User defined event monitoring and
           reporting e.g. readmissions tracking or use
           of antidote drugs such as naloxone
CDS 29     Definition of clinical algorithms
CDS 30     Statistical Modeling (e.g. regression, time
           series, ANOVA)


                                  ce889d78-b37a-40aa-911d-6676ae69d824.xls/CDS
VENDOR     [Enter Vendor Name Here]                                                               FORM A
                                                                                 FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                         (CDS) CLINICAL DECISION SUPPORT
  A=       [Enter Application A Here]                               D= [Enter Application D Here]
  B=       [Enter Application B Here]                               E= [Enter Application E Here]
  C=       [Enter Application C Here]                               F= [Enter Application F Here]


 ID                    DESCRIPTION                        STATUS*         SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
CDS 31     Provide modeling, optimization, critical
           success analysis, and „what-if‟ scenarios.

CDS 32     Reminders/alerts may be differentiated by
           clinical category e.g. radiology studies,
           medication order checks, lab studies, etc.

CDS 33     Reminders/alerts may be differentiated by
           desired goal:
           a. Adverse event detection
           b. Prevention
           c. Promoting standard care paths
           d. Reduced utilization
CDS 34     Provides direct one for one alternative e.g.
           suggests less costly drug in place of one
           ordered.
CDS 35     Provide structured order entry (See OEM)

CDS 36     Processing of allergy and drug-drug
           interactions is supported through drug
           family processing.
CDS 37     Provide rules based event detection using
           Boolean or other logic.
CDS 38     Provides relevant information display e.g.
           important ancillary information or reference
           information pertinent to an action as
           defined by the user.
CDS 39     Show charges for interventions,
           procedures, laboratory, and medications
           when they are being ordered.
CDS 40     Provides redundant utilization checks e.g.
           redundant interventions:
           a. Based on a given time interval
           b. Based on excessive overall charges
           c. Based on other patterns that suggest
           overuse of services




                                  ce889d78-b37a-40aa-911d-6676ae69d824.xls/CDS
VENDOR       [Enter Vendor Name Here]                                                          FORM A
                                                                              FUNCTIONAL REQUIREMENTS
  APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                 (RES) Resource Scheduling
    A=       [Enter Application A Here]                            D= [Enter Application D Here]
    B=       [Enter Application B Here]                            E= [Enter Application E Here]
    C=       [Enter Application C Here]                            F= [Enter Application F Here]

    ID       DESCRIPTION                                     STATUS*    SOURCE COMMENTS
  *STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
             GROUP TREATMENT AND
             SCHEDULING
  RES    1   System maintains and displays an
             inventory of patient groups and group
             activities (by program) including information
             on:
             a. Group name
             b. Group code
             c. Associated CPT code
             d. Group description
             e. Group leader (Table driven)
             f. Group backup leader (Table driven)
             g. Group day or days (Table driven)
             h. Group time or times (Associate with
             each group day)
             i. Group location
             j. Group duration
             k. Group charge / price
             l. Group charge code
             m. Group attendance method indicator
             n. Maximum group capacity
             o. Billable status
             p. Program track associated with group

             q. Automatic attendance list printing (Y/N)
             r. Additional programs group is open to
             (Table driven)
   RES 2     System builds group membership lists for
             viewing, reporting, or charting by scanning
             interventions listed in patient Treatment
             Plan (see BHT).
   RES 3     System can print, display, or download to
             wordprocessing file, a formatted catalog of
             groups and activities by program with table
             of contents.
   RES 4
             System automatically updates appointment
             scheduler when a staff member is assigned
             as a leader of group by creating an ongoing
             appointment for group coverage for days
             and times that group takes place.
   RES 5     Attempt to change the time of a group is
             checked against the appointment
             scheduler to ensure that staff person is free
             for ongoing appointments at desired new
             time for group.
  ID       DESCRIPTION                                      STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 RES 6     Termination of group automatically updates
           appointment scheduler.
 RES 7     Changes in group leader automatically
           update appointment scheduler.
 RES 8     System does not allow staff to be assigned
           to more than one group for the same day
           and time.
 RES 9     When assigning a group to a staff person,
           system checks against data in appointment
           scheduler.
 RES 10    Appointment scheduler checks against
           Table of Groups and Activities to see if
           staff person might be required to backup a
           group at time an appointment is being
           scheduled for and warns user of potential
           conflict.
 RES 11    Patients are assigned to groups by adding
           the group to the interventions list on the
           Treatment Plan and patient schedules are
           updated accordingly.
 RES 12    Patients can also be assigned to groups
           directly via appointment scheduler but an
           ongoing assignment can only be scheduled
           if user agrees to add group to patient's
           Treatment Plan.
 RES 13    Upon assigning a group via Treatment Plan
           or Appointment Scheduler, system checks
           number in group and, if group has reached
           capacity, informs user and presents user
           with option to add patient to waiting list for
           group.
 RES 14    System does not display on waiting list
           status on Treatment Plan or on official
           medical record, but keeps data available to
           the user on demand.
 RES 15
          System checks each evening to see if
          there are openings for groups that have
          persons on waiting list and if so, alerts
          appropriate staff upon next sign-on, and
          provides option to immediately add patient.
 RES   16 System has ability to take patient off a
          waiting list when patient is assigned to
          group.
 RES   17
          System provides mechanism for removing
          patient from group waiting list and does so
          automatically if patient is discharged from
          program or group is terminated.
 RES   18 Provide authorized users with means to
          indicate the group to be documented.
 RES   19
          System builds list of group members from
          scanning appropriate Treatment Plans.
  ID      DESCRIPTION                                   STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 RES 20
        Allow users to move down list and indicate
        attendance code exceptions according to
        attendance indicator applicable to the
        group as set up in Master Group File.
 RES 21 System Prompts user to add attendees not
        on list.
 RES 22 Provide ability for authorized user to update
        Treatment Plans (add group as
        intervention) for newly added attendees.
 RES 23
        System warns user that service may not be
        reimbursed if user chooses not to add
        group to Treatment Plan interventions.
 RES 24 If user overrides warning, appropriate staff
        are notified electronically.
 RES 25 After indicating attendance in group,
        system allows entry of general group note
        that system created for each group
        attendee.
 RES 26 After entry of group note, system scrolls
        through the individual group notes for each
        patient assigned to group and allows user
        to add to or modify general group note.

 RES 27 For patients scheduled who did not attend
        group, system creates note indicating that
        patient did not attend and provides
        mechanism for user to add to or modify this
        note.
 RES 28 When entering group notes, user can attest
        to entire set of notes with a single action
        (no need to attest to each group members
        note individually).
 RES 29
        Allow authorized user to define restrictions
        on who can and cannot schedule multiple
        or single groups and provide warnings.
          TEST/PROCEDURE/CLINIC
          APPOINTMENTS
 RES 30 Schedulers may access patient registration
        system online and automatically transfer
        patient identification data for scheduling
        purposes, including names, medical record
        number, Health Center control number
        (MPI), age, phone number, and other data
        fields as defined by the Department.


 RES 31 Accept and display patient identification
        information, including:
        a. Name
        b. Medical record number / short - doyle
        c. Health Center identification number
  ID      DESCRIPTION                                      STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
          d. Age
          e. Account number
          f. Program
          g. Sex
          h. Phone number
          I. Desired date, time, and location for
          appointment
 RES 32   Patient scheduling data fields include:
          a. Desired appointment date.
          b. Desired time.
          c. Location.
          d. Clinician
          e. Free text comment field (minimum 200
          characters).
 RES 33   Provide for online inquiry of available
          appointments by:
          a. Clinician and/or resource
          b. Date
          c. Location
          d. Time
 RES 34   Automatically schedule procedures which
          must be performed in proper sequence,
          with proper sequences defined according
          to user protocols.
 RES 35   Perform online conflict checking to facilitate
          scheduling of procedures that must be
          performed in proper sequence.
 RES 36   Automatically indicate procedure or
          schedule conflicts.
 RES 37   Automatically indicate client specific
          warnings to include:
          a. Aggression warning
          b. Contraband warning
          c. No show history
 RES 38   Accommodate changes in appointment
          dates both for individual patients and for
          identified groups of patients (e.g.,
          reschedule an entire day's patient load).
 RES 39   Provide visual and auditory notification of
          changes in schedules to affected
          departments.
 RES 40   Automatically schedule/cancel/confirm
          individual and/or series of appointments for
          one or more patients, for up to a user-
          defined number of months in advance.
 RES 41   Display or print (at user's option) "next
          available" time blocks by resource.
 RES 42   Print appointment slips.
 RES 43   Flag patients with a history of no-shows.
          Print reports of no show patients according
          to Health Center-defined no-show
          threshold.
 RES 44   Print or display (at user's option) a list of
          scheduled patients by service area and
          time 24 hours in advance.
  ID       DESCRIPTION                                      STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 RES 45 Print or display (at user's option) a list of all
        patients scheduled clinic-wide by time and
        service area 24 hours in advance.

 RES 46 Allow authorized personnel to print or
        display a given patient's daily schedule
        selected by day, week, or month.
 RES 47 Print or display (at user's option) daily,
        weekly, or monthly schedules.
 RES 48 Offsite physician offices may access the
        system via telephone modem for
        displaying/printing schedules, booking, or
        changing appointments, and updating
        patient information.
 RES 49 Access to all fields, screens, and functions
        may be limited to select users via system
        security.
 RES 50 Access to all fields and screens can be
        limited to "read only" via system security.

        RESOURCE MANAGEMENT
 RES 51 For all resource areas print or display (at
        user's option) listing of scheduled activity
        by patient, showing order, department, and
        time of day, for future appointments.

 RES 52 Maintain appointment records online for
        user-defined number of months.
 RES 53 Print statistical reports showing resource
        utilization based on predetermined
        capacity, time elapsed or full time
        equivalents (FTEs) by job type.
 RES 54 Print reports listing and comparing
        scheduled and actual visits, including "no
        shows" and cancellations.
 RES 55 Print an audit trail of all transactions.
 RES 56 Permit manual override of scheduled
        appointments (e.g., emergency).
 RES 57 Allow a resource area to verify scheduled
        time assigned elsewhere and re-schedule
        service if necessary.
 RES 58 Print reports by department showing
        numbers of no-shows by month, day, and
        year.
 RES 59 Print a pre-visit reminder postcard "X" days
        in advance of an appointment, with "X"
        being user-defined (should contain a memo
        field).
 RES 60 Print a pre-visit reminder list by area, by
        patient including phone numbers, "X" days
        in advance of an appointment, with "X"
        being user-defined.
 RES 61 Specify alternative contact for reminder
        such as guardian, parent, etc.
  ID      DESCRIPTION                                  STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 RES 62 Allow each resource department and
        subdepartment to identify procedure-
        specific scheduling criteria including:
        a. Time.
        b. Day of week.
        c. Conflicts.
        d. Order in which procedures must be
        done.
        e. Length of appointment slots.
        f. Number of appointment slots per
        scheduling session.
        g. Number of sessions per week or month.

          h. Special scheduling instructions (e.g.,
          schedule only certain types of patients on
          certain days).
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                               (QAF) Quality Assurance-Followup

  A=       [Enter Application A Here]                                D= [Enter Application D Here]
  B=       [Enter Application B Here]                                E= [Enter Application E Here]
  C=       [Enter Application C Here]                                F= [Enter Application F Here]


 ID                     DESCRIPTION                        STATUS*         SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID

           Quality Assurance / Followup
QAF 1      Maintain the following data elements on all
           types of Quality Assurance/Follow-up
           cases:
           a. Patient name
           b. Patient address
           c. Medical record number
           d. Account number
           e. Quality assurance identification number

           f. Home phone number
           g. Work phone number
           h. Date of birth (and age automatically
           i. Sex
           j. Client name
           k. Client identification number
           l. Date of intervention
           m. Date of Incident
           n. Follow-up Required (up to fifteen preset
           options)
           o. Abnormalities/diagnosis (up to fifteen
           preset options by exam type)
           p. Outcomes (up to fifteen preset options
           by exam type)
           q. Action Date
           r. Clinician
           s. Completion Date
           t. Occupation
           u. Referral source
           v. Email address
           w. Social Security number
           x. Financial class
QAF 2      Accommodate definition of Quality
           Assurance criteria against which patient
           treatment data can be compared (i.e.,
           predefined set of results with
           normal/significant ranges for each exam
           type)
QAF 3      Maintain records of cases which fall within
           the defined abnormalities/follow-up criteria,
           including:
           a. Criteria involved
           b. Name of Clinician


                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/QAF
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                               (QAF) Quality Assurance-Followup

  A=       [Enter Application A Here]                                D= [Enter Application D Here]
  B=       [Enter Application B Here]                                E= [Enter Application E Here]
  C=       [Enter Application C Here]                                F= [Enter Application F Here]


 ID                     DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
           c. Required Action -- organizational and
           individual
           d. Tracking of calls to patient
           e. Outcome of follow-up/review process
           f. Reassessment for problem resolution
           g. Follow-up reminder date
           h. Auto-generation of follow-up lists based
           on user-selected date or range of dates

QAF 4      Allow override or modification of defined
           criteria for special projects or review.
QAF 5      Maintain records of Complaints, including:

           a. Type/nature of complaint (table driven
           complaint codes)
           b. Free form text to detail the complaint
           c. Date of complaint
           d. Source of complaint (e.g., client,
           provider, parent)
           e. Name and type of staff, service, or
           f. Outcome of review process
           g. Action taken
           h. Attribution
           i. Follow up
           j. Comments/Notes
QAF 6      Ability to flag a specific record for special
           attention to users (e.g., do not contact
           patient).
QAF 7      Accommodate a referral process for quality
           issues and cases with significant results
           which fall outside of entity-defined services,
           including the following criteria:

           a. Type of referral (Primary Physician,
           b. Referral date
           c. Source of referral
           d. Referral reason
           e. Referral response date
           f. Referral response
QAF 8      Provide a year-to-date report of all cases
           requiring follow-up.
QAF 9      Provide a summary report by QA reviewer
           including the following:
           a. Number of cases reviewed

                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/QAF
VENDOR     [Enter Vendor Name Here]                                                                 FORM A
                                                                                   FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                (QAF) Quality Assurance-Followup

  A=       [Enter Application A Here]                                 D= [Enter Application D Here]
  B=       [Enter Application B Here]                                 E= [Enter Application E Here]
  C=       [Enter Application C Here]                                 F= [Enter Application F Here]


 ID                     DESCRIPTION                          STATUS*        SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
           b. Number of significant results identified
           c. Average days for initiating follow-up
           d. Average number of follow-up calls
           required to obtain an outcome/ response
           e. Total number of calls made
           f. Total number of clinicians called
           g. Total clients called
QAF 10     Access Clinician Profile from Staff Master
           for clinician identification information.

QAF 11     Provide ability to track Abnormality cases
           through multiple levels of review:
           a. Status of review at each level
           b. Follow-up required at each level
           c. Action taken at each level
QAF 12     Provide ability to perform Care Evaluation
           Studies based on any information in the
           Quality Assurance files, including the
           following:
           a. Sort by up to any five per performance
           measures as defined by the Department
           b. Cross tabulation between any data
           elements
           c. Compare numbers of reviews to
           numbers of "denominators" (e.g.,
           abnormalities by procedure out of total
           number of procedures)
           d. Trend data historically (at least three
           years)
           e. Provide ability to merge items from
           different files, and identify items that do not
           match.
           f. Produce standardized departmental
           specific reports.
           g. Automatically generate QA
           reminders/lists for call-backs and follow-up

           h. Automatically produce customizable
           follow-up letters to send to clients (selected
           from a pre-defined set of letters)

QAF 13     Provide summary report by program and
           clinician for review by QA staff



                                    ce889d78-b37a-40aa-911d-6676ae69d824.xls/QAF
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                               (QAF) Quality Assurance-Followup

  A=       [Enter Application A Here]                                D= [Enter Application D Here]
  B=       [Enter Application B Here]                                E= [Enter Application E Here]
  C=       [Enter Application C Here]                                F= [Enter Application F Here]


 ID                     DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
QAF 14     Provide facility for Adhoc database
           assimilation of custom QA questionnaires
           and surveys.
QAF 15     Ability to add or remove a specific
           abnormality within client profile as well as
           within preset options.
QAF 16     Ability to define access to Quality
           Assurance features by department, by
           staff, by provider (i.e., inquiry only access,
           modification/edit capabilities).
QAF 17     Corrections/revisions to client demographic
           information made in Quality Assurance
           module should be automatically reflected in
           all modules and locations (e.g., scheduling,
           patient record).

QAF 18     Ability to transfer, or store, patient
           comments from prior year in current year‟s
           patient file/ record.




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/QAF
VENDOR [Enter Vendor Name Here]                                                                       FORM A
                                                                                     FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                         (CAV) Clinician Access View
  A=      [Enter Application A Here]                                     D= [Enter Application D Here]
  B=      [Enter Application B Here]                                     E= [Enter Application E Here]
  C=      [Enter Application C Here]                                     F= [Enter Application F Here]


 ID                       DESCRIPTION                           STATUS*           SOURCE         COMMENTS
                                                                           (A-F)
           *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID

          CLINICIAN ACCESS
CAV     1 Provide online access both locally and remotely
          via the Internet to ADT system for client
          demographics, location, and census information,
          via integrated desktop work environment.

CAV     2 Provide online access both locally and remotely
          via the Internet to Data Repository for medical
          and clinical information, including treatment
          plans, progress notes, and assessments.

CAV     3 Provide online access both locally and remotely
          via the Internet to Scheduling system for
          resource scheduling information.
CAV     4 Provide online access both locally and remotely
          via the Internet to Order Entry for transmission of
          orders, and status check on orders.

CAV     5 Provide online access both locally and remotely
          via the Internet to staff and oncall schedules.

CAV     6 Provides ability to conform with Health System
          patient confidentiality requirements (see SEC).

CAV     7 Provide context based switching between
          application modules (e.g., no need to reidentify
          patient when switching applications).

CAV  8 Notify primary clinician via email, autofax or
       letter, when their client is accessing the Health
       Care System as defined by the user, e.g.,
       schedules appointment with specialist,
       registered in ED, etc.
CAV  9 Provide each clinician with display and printed
       listing of his/her clients that are active and open,
       with patient demographics, and diagnosis and/or
       service.
CAV 10 Provide each clinician with display and printed
       listing of his/her Group/Team's clients that are
       active and open, with patient demographics, and
       length of stay by diagnosis and/or service.




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/CAV
VENDOR [Enter Vendor Name Here]                                                                      FORM A
                                                                                    FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                        (CAV) Clinician Access View
  A=      [Enter Application A Here]                                    D= [Enter Application D Here]
  B=      [Enter Application B Here]                                    E= [Enter Application E Here]
  C=      [Enter Application C Here]                                    F= [Enter Application F Here]


 ID                      DESCRIPTION                          STATUS*            SOURCE         COMMENTS
                                                                           (A-F)
           *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
CAV 11 Provides several defined patient lists. These lists
       are produced by a clinician signing on.
CAV 12 A list of all previously seen clients for whom new
       data is available.
CAV 13 The caregiver may select a different patient list
       as a default sign-on screen for different settings,
       i.e.., inpatient lists for inpatient sign-on, office
       schedule lists for office sign-on, and so forth.

CAV 14 The caregiver may, from the sign-on in any
       setting, select a different patient list from the
       chosen default list with no more than two key
       strokes or mouse clicks. .
CAV 15 Patient lists as defined above will display no less
       than 15 patients per screen.
CAV 16 The caregiver can print, using no more than 1
       keystroke or mouse click, a copy of the above
       list.
CAV 17 Color indicators are provided on patient list
       screens as defined above, which indicate new,
       abnormal, or critical data and the data is
       accessible by either 1 click of a mouse or 1
       keystroke.
CAV 18 Provide Electronic messaging capability for
       communication with staff.
CAV 19 Provide online prompts where signatures or co-
       signatures are required in the completion of
       medical records documentation to avoid charting
       deficiencies
CAV 20 Provide online access both locally and remotely
       via the Internet to one or more databases (e.g.,
       Medline) of bibliographic information.

CAV 21 Provide online access both locally and remotely
       via the Internet to drug information databases
       and texts.




                                  ce889d78-b37a-40aa-911d-6676ae69d824.xls/CAV
VENDOR [Enter Vendor Name Here]                                                          FORM A
                                                                        FUNCTIONAL REQUIREMENTS

APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                           (INC) INCIDENT REPORTING

  A=       [Enter Application A Here]                        D= [Enter Application D Here]
  B=       [Enter Application B Here]                        E= [Enter Application E Here]
  C=       [Enter Application C Here]                        F= [Enter Application F Here]

ID         DESCRIPTION                                 STATUS*    SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           Incident Related Notes including, at a
INC    1   minimum, the following:
           a. Aggression Control Note




           unlimited free text)

           b. Seclusion and Restraint Note including




           restraint/seclusion

           c. Special Precautions Note
           d. Suicidal ideation/behavior Note
           e. Allergic Reaction Note including




           f. Activity Restriction Note
           g. Contraband Note
           h. Three Day Letter
           i. PRN administration Note
           j. Communication Restriction Note
           k. Physical Contact Note
           l. Note of Treatment Refusal
           m. Report of Code Called
           n. Medication Side Effect Note including




           o. Elopement Note
           p. Client Complaint Note
          q. Report of client Illness
          r. Emergency Room Transfer Note
          including




          Allow users to enter new notes or append
          to existing notes at a later date with system
          tracking the time and date of entry or
INC   2   append.

INC   3   Assign a unique Incident Tracking Number
          The format and template of the incident
          note can be customized based on the type
INC   4   of incidents.
          Enable the flexible creation of state
INC   5   required incident reports.
          Enable the saving of incident reports to a
INC   6   Microsoft Word document.
          Enable the emailing of incident reports to
INC   7   the State.
          Enable the automatic faxing via a fax
INC   8   server of incident reports to the State.

          Incident reports can be automatically
          generated based on Department specified
INC   9   parameters of severity and type of incident.

         Create incident log summary reports by
         Department specified time periods
INC   10 including daily, weekly, monthly, and yearly.
         Mechanism of relating individual incidents
INC   11 to each other.
VENDOR [Enter Vendor Name Here]                                                              FORM A
                                                                            FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                (CLP) Pathways / Guidelines
  A=       [Enter Application A Here]                           D= [Enter Application D Here]
  B=       [Enter Application B Here]                           E= [Enter Application E Here]
  C=       [Enter Application C Here]                           F= [Enter Application F Here]


 ID                     DESCRIPTION                        STATUS*   SOURCE             COMMENTS
                                                                       (A-F)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 CLP 1     Provide the capability to develop custom
           pathways and guidelines.
 CLP 2     Ability to modify any provided sets of
           pathways and guidelines
 CLP 3     Pathways and guidelines are tied to the
           generation of treatment plans and
           assessments (see BHA and BHT).
 CLP 4     Can be displayed as a calendar of clinical
           events to be accomplished.
 CLP 5     Can be displayed organized by care
           provider type (e.g., Therapist, psychiatrist,
           financial planner).
           Mental Health
 CLP 4     Offer a mental health diagnosis decision
           matrix that addresses the continuity of
           interventions in treatment planning.
 CLP 5     Use other industry standard pathways and
           guidelines (Please specify)
           Alcohol / Substance Abuse
 CLP 6     Use the American Psychiatric Association's
           practice guidelines for the treatment of
           client's with substance abuse disorders.

 CLP 7     Use the SAMHSA Treatment Improvement
           Protocols.
 CLP 8     Use the ASAM PPC II R decision matrix
 CLP 9     Use other industry standard pathways and
           guidelines (Please specify)
           Dual Diagnosis
 CLP 10    Offer a dual diagnosis decision matrix that
           addresses the continuity of interventions in
           treatment planning following:

           a. Low severity mental illness/low severity
           substance abuse
           b. Severe and persistent mental
           illness/substance abuse
           c. low severity psychiatric disorder/high
           severity substance disorder
d. severe and persistant mental illness/high
severity substance disorder
e. high severity psychiatric but not severe
and persistant mental illness/high severity
substance disorder
VENDOR   [Enter Vendor Name Here]
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                             (ERX) ePrescriptions
 A=      [Enter Application A Here]                                   D= [Enter Application D Here]
 B=      [Enter Application B Here]                                   E= [Enter Application E Here]
 C=      [Enter Application C Here]                                   F= [Enter Application F Here]


 ID                      DESCRIPTION                             STATUS*   SOURCE
                                                                          (A-Z)
          *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
         GENERAL REQUIREMENTS
ERX 1    Print client prescription instruction monographs.



ERX 2    Online physician desk reference
ERX 3    Retrieve client's demographic information at the
         point of prescription writing.
ERX 4    Retrieve client's treatment plan and notes at the
         point of prescription writing.
ERX 5    Interactively review client's medication history.
ERX 6    Integrated with Client benefits management to
         determine co-pay and medication benefit limits.

ERX 7    Maintain approved formularies.
ERX 8    Maintain multiple approved formularies, one for
         each payer type. The appropriate approved
         formulary is automatically accessed determined
         by the client payer/fund source.
ERX 9    Print legible prescription.
ERX 10   Fax prescription to designated pharmacies via a
         fax server.
ERX 11   Email encrypted prescription to designated
         pharmacies.
ERX 12   Supports digital signature to include the following:

         a. Ability to add a time stamp as part of a digital
         signature.
         b. The capability to verify the signature without the
         cooperation of the signer
         c.The assurance of unaltered transmission and
         receipt of a message from the sender to the
         intended recipient.
         d. Non-repudiation. Strong and substantial
         evidence of the identity of the signer of a
         message, and of message integrity, sufficient to
         prevent a party from successfully denying the
         origin, submission, or delivery of the message
         and the integrity of its contents.
         e. The ability of a signed prescription to be
         transported over an insecure network to another
         system, while maintaining the integrity of the
         document, including content, signatures,
         signature attributes, and (if present) document
         attributes via encryption.
ERX 13   Support approved formulary listings to display
         drugs determined to be 'first-choice' by the
         Department.
ERX 14   Provide clinical error reduction technology
         including:
         a. drug-drug interactions
         b. Dosing
ERX 15   Support wireless prescription device solution
         including:
         a. Touch-screen technology
         b. Voice recognition technology
         c. Stylus-based interface
                       FORM A
      FUNCTIONAL REQUIREMENTS
                 (ERX) ePrescriptions
nter Application D Here]
nter Application E Here]
nter Application F Here]


                  COMMENTS
TOM, W=WON'T, D=DIDN'T BID
General System Functions
VENDOR    [Enter Vendor Name Here]                                                                 FORM A
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                               (MEN) Multientity
 A=       [Enter Application A Here]                                D= [Enter Application D Here]
 B=       [Enter Application B Here]                                E= [Enter Application E Here]
 C=       [Enter Application C Here]                                F= [Enter Application F Here]


 ID                    DESCRIPTION                         STATUS*       SOURCE             COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
                 GENERAL REQUIREMENTS
MEN 1     Provide a utility to copy user-designated
          dictionaries and master files from one
          corporate entity to another, based on
          authorized user security level.
MEN 2     Allow user to move from one entity to
          another within the same application with a
          single command.
MEN 3     Establish and maintain distinct and
          complete training environments for each
          corporate entity.
MEN 4     Provide multilevel roll-up for all reports and
          online summary screens across all user-
          designated entities.
MEN 5     Allow common data to be entered once and
          "exploded" to the user-designated entities
          without requiring redundant data entry for
          each entity.
MEN 6     Allow user messages and comments to be
          sent from one entity to another.
MEN 7     Restrict access for given functions at the
          following levels:
          a. Corporate entity.
          b. Department
          c. Provider type
          d. Site/location
          e. User
MEN 8     At authorized user's option allow creation
          and maintenance of distinct Service Item
          Masters and charge numbering schemes
          for separate entities.

MEN 9     Roll up all standard reports across user-
          designated groups of entities or all entities.

MEN 10    Forms, letters, instructions, and reports can
          be identical or different based on user
          defined requirements.




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/MEN
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                                     (SEC) Security
   A=      [Enter Application A Here]                               D= [Enter Application D Here]
   B=      [Enter Application B Here]                               E= [Enter Application E Here]
   C=      [Enter Application C Here]                               F= [Enter Application F Here]


 ID                     DESCRIPTION                       STATUS*         SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 SEC     1 Control access to authorized functions via
           the user's sign-on ID and password using
           the following:
           a. Role based where User Groups are
           created with access levels, and individuals
           are assigned to those groups
           b. User based where each individual user
           is assigned the approved access levels.

           c. Maintain an emergency access login,
           that has the password reset after each use.

           d. Other
 SEC     2 Print at authorized user request, an audit
           report of every transaction initiated on the
           system, identifying the location, date and
           time, function, file accessed, and security
           access code of the user. The audit report
           can be defined by function.

 SEC     3 Warns system administrator in real time
           when user has tried to access restricted
           sensitive data as defined by Health Care
           System.
 SEC     4 Provide means to limit the number of
           warnings or set a threshold for warnings.
 SEC     5 Clilent confidentiality can be protected
           when data is extracted from repository
           through encryption of client identifier
           columns to include:
           a. Name
           b. Client number
           c. Account number
           d. Social Security number
           e. Plan ID / Group Number
           f. Phone numbers
           g. Addresses
 SEC     6 Allow authorized user personnel to initiate,
           modify, and cancel security designations of
           staff.
 SEC     7 Create documentation of new, modified,
           and canceled security designations for
           administrative filing.




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/SEC
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                                     (SEC) Security
   A=      [Enter Application A Here]                               D= [Enter Application D Here]
   B=      [Enter Application B Here]                               E= [Enter Application E Here]
   C=      [Enter Application C Here]                               F= [Enter Application F Here]


 ID                     DESCRIPTION                        STATUS*        SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 SEC     8 Restrict access for given functions by
           location or designation of terminal and/or
           time of day, day of week.
 SEC     9 Allow multilevel, read-only access to the
           system by authorized personnel only.
 SEC    10 Restrict additions to, changes to, and/or
           deletion of records by security level to only
           those authorized.
 SEC    11 At user's request, print management report
           of security access by application and by
           department.
 SEC    12 Display an online alert and optional report
           to a designated terminal when certain,
           Health Care System-specified security
           violations occur. These could include
           unauthorized external dial-up access, or
           access using specific security codes. \

 SEC 13 Display a message online at Health Care
        System-designated points warning users
        that a record of their access is being
        maintained.
 SEC 14 System provides a 'terminal disable' if a
        user's password is entered incorrectly a
        specified number of times.
 SEC 15 Data sent over the public network can be
        encrypted using the following:
        a. Secure Socket Layer
        b. PKI
        c. DDE
        d. Other (Please Specify)
 SEC 16 Provide 'time-out' feature if inactive for a
        specified period of time. (Backout any
        active transaction)
 SEC 17 Time-out may be made terminal-specific
 SEC 18 Time-out may be made user-specific
 SEC 19 Time-out may be made User Role specific

 SEC 20 Each user's account can be restricted by
        time (day of week, time of day, etc.).
 SEC 21 User accounts can be built with expiration
        dates (temporary employees).
 SEC 22 Users can be connected to a group and
        gain resource access at the group level.



                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/SEC
VENDOR     [Enter Vendor Name Here]                                                               FORM A
                                                                                 FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                                    (SEC) Security
   A=      [Enter Application A Here]                              D= [Enter Application D Here]
   B=      [Enter Application B Here]                              E= [Enter Application E Here]
   C=      [Enter Application C Here]                              F= [Enter Application F Here]


 ID                    DESCRIPTION                       STATUS*         SOURCE            COMMENTS
                                                                       (A-F)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
 SEC 23 User may belong to more than one security
        group.
 SEC 24 Require users to change passwords every
        x days as specified by the security
        administrator.
 SEC 25 Designated users can not be signed on to
        more than one terminal (device) at a time
        with the same account/password.
 SEC 26 Provide a report of user Logon ID‟s not
        used for a specified time.
 SEC 27 Provide a report of user's activity per sig-on
        for productivity tracking.
 SEC 28 Provide alternate user authentication
        methods other than the typical keypad
        entered user id and password including:
        a. biometrics
        b. token card
        c. PIN
        d. Other
 SEC 29 Provide a function whereby a user (likely a
        clinician) can list the names of all who have
        accessed a specific patient's record.

 SEC 30 Able to receive a message and/or file from
        the Human Resources system indicating
        terminated employees, and automatically
        turn off access.




                                  ce889d78-b37a-40aa-911d-6676ae69d824.xls/SEC
VENDOR     [Enter Vendor Name Here]                                                          FORM A
                                                                            FUNCTIONAL REQUIREMENTS
  APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                     (IEN) Interface Engine
    A=     [Enter Application A Here]                            D= [Enter Application D Here]
    B=     [Enter Application B Here]                            E= [Enter Application E Here]
    C=     [Enter Application C Here]                            F= [Enter Application F Here]

    ID     DESCRIPTION                                     STATUS*    SOURCE COMMENTS
  *STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           DATA CAPTURE
   IEN 1   Perform capture of simultaneous data
           transaction streams from multiple senders
           within the network.
   IEN 2   Support the use of screen scraping when
           no formal application interface is available.

   IEN 3   System provides 'pre-packaged'
           communication clients to acquire and send
           data from and to the major information
           systems in use at SCVHHS, including:

           a. Siemens/SMS Invision OpenLink
           b. Lawson
           c. Diamond
           d. WebMD (previously MedeAmerica)
           pharmacy
           e. CSM M4 Methadone
           DATA MANIPULATION
   IEN 4   Allow data from a sender to be manipulated
           before being passed onto the receiver(s):

           a. Translate from 1 value to another
           b. Assemble discrete data elements into 1

           c. Coordinate discrete messages into 1
           d. Hold for future action or state
           e. Substring text
           f. Convert data types (e.g., text->numeric)

           g. Change element length
           h. Format (e.g., adding dashes to a phone
           number)
   IEN 5   Provide tools to create routines that
           automatically modify the content of
           messages, and perform message routing.

   IEN 6   Allow a single input transaction to be
           broadcast to multiple receivers.
   IEN 7   Allow different data manipulation mappings
           and formats for each broadcast message
           and each receiver message.

   IEN 8   Provide facilities for complex data
           conversions including:
           a. Database lookups
  ID     DESCRIPTION                                   STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
         b. Conditional operations
 IEN 9   Provide ability to route messages to
         various combinations of applications and
         platforms based upon message content
         and pre-defined rules.
         DATA TRANSMISSION
 IEN 10 Provide ability to "store and forward"
        messages when receiver is down without
        manual intervention.
 IEN 11 Provide ability to resend transactions, on
        demand, for a given time period.
 IEN 12 Provide alert notification if a scheduled
        sender does not transmit.
 IEN 13 Provide alert notification for messages
        stored for a period greater than a user-
        definable period of time.
         RELIABILITY
 IEN 14 Provide around-the-clock (24 hours per
        day, 7 days per week) interface engine
        operation.
 IEN 15 Provide ability to add new interfaces,
        devices, and applications without taking
        down the interface engine.
 IEN 16 Provide ability to add new interfaces,
        devices, and applications without vendor
        involvement.
 IEN 17 Perform backups without taking down the
        interface engine.
 IEN 18 Provide ability to log messages for recovery
        and error correction.
 IEN 19 Provide ability to dial beepers or phones,
        and send electronic mail, as well as notify
        the interface engine console when interface
        failures occur.
 IEN 20 Provide an automated mechanism for re-
        synchronizing the transaction flow when
        bringing up a new receiving system or after
        a failure.
 IEN 21 Provide system redundancy and fail-safe
        mechanisms.
 IEN 22 Provides the ability to share tasks across
        multiple interface engine systems with
        hardware and application failover occurring
        without manual intervention.

 IEN 23 Failed transactions may be examined
        online and corrected by authorized
        personnel prior to retransmission.
         SECURITY
 IEN 24 Perform security checks on messages
        passed between application systems.
  ID     DESCRIPTION                                   STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 IEN 25 Protect application definitions, routing
        information, and interface message
        definition from unauthorized access.
 IEN 26 Provide ability for the interface engine to
        serve as a security manager by providing a
        menu of authorized applications based on
        the user's sign-on ID.
 IEN 27 Present a customized menu of applications
        to each user depending on their security
        authorizations.
 IEN 28 Support the use of encryption for
        messages passed between systems.
 IEN 29 Support the use of centralized
        authentication servers as part of access
        control.
 IEN 30 Support the use of multiple levels of user
        ID and password access control.
 IEN 31 System provides a console lock with
        keyboard inactivity timeout.
         BUILDING INTERFACES
 IEN 32 Provide a graphic user interface for
        specifying data mappings and control
        functions.
 IEN 33 Provide the ability to trap an incoming
        message for mapping definition through
        population of list boxes.
 IEN 34 Track and report on fields available and
        used in designing mapping relationships.
         PERFORMANCE MONITORING AND
         OPTIMIZATION
 IEN 35 Allow messages to be displayed and/or
        written to a file for debugging purposes.
 IEN 36 Provide facilities for auditing and
        performance monitoring.
 IEN 37 Provide ability to prioritize messages and
        transactions depending on content or
        source of message.
 IEN 38 Provide for log retention for user-defined
        periods.
 IEN 39 Provide ability to export logs to standard
        database formats, including, but not limited
        to the following:
        a. Microsoft Access
        b. Comma delimited ASCII
        c. Microsoft Excel
 IEN 40 Provide summary reporting regarding
        performance of the interface engine.
 IEN 41 Provide cumulative performance reporting
        for day, week, month, quarter, year, or
        other user-defined periods.
 IEN 42 Provide ability to display graphically the
        performance data on screen and in printed
        output.
  ID      DESCRIPTION                                   STATUS*   SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
 IEN 43 Provide graphical user interface display of
        gateway status, activity, and performance.

 IEN 44 System provides for ability to down the
        interface engine and maintains ability to
        restart transmissions after service
        resumption.
 IEN 45 System provides an authorized user the
        ability to halt a transaction in progress
        without loss of the message data.
 IEN 46 System provides an authorized user the
        ability to reorder or modify transactions in
        the queue.
          TECHNICAL ENVIRONMENT
 IEN 47 Support a multi-tasking operating
        environment.
 IEN 48 Provide support for Application Level
        Transaction Standards relevant to the
        medical industry including, but not limited
        to the following:
        a. HL7
        b. ANSI X12N 4010
 IEN 49 Provide an environment for testing
        modifications, additions, and changes
        before implementation.
 IEN 50 Support "hot" changes to the production
        environment.
 IEN 51 Support the ability to convert graphic and
        image formats, including, but not limited to,
        the following:
        a. DICOM
        b. JPEG
        c. GIF
        d. WMF
 IEN 52 Provide connectivity/emulation software
        that supports the following communication
        protocols/options:
        a. Ethernet (i.e., 802.3)
        b. Fast Ethernet
        c. RS232 Async
        d. IBM JES2 RJE
        e. TCP/IP
        f. DECNET
 IEN 53 Support facsimile (inbound and outbound)
        transmission.
 IEN 54 The system will operate on the following
        operating platforms:
        a. DEC UNIX
        b. HP-UX
        c. RS/6000 (AIX)
        d. Microsoft Windows NT
        g. Other (please specify)
VENDOR     [Enter Vendor Name Here]
                                                                            FUNCTIONAL REQUIREMENTS
  APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES
    A=     [Enter Application A Here]                            D= [Enter Application D Here]
    B=     [Enter Application B Here]                            E= [Enter Application E Here]
    C=     [Enter Application C Here]                            F= [Enter Application F Here]

    ID      DESCRIPTION                                    STATUS*    SOURCE
  *STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
           Provide an online screen building utility
           enabling authorized users to place data
           elements (from a data dictionary) onto
   SCR 1   screen.

           All screen building functionality as detailed
   SCR 2   below is for the following screen types:
           a. Data Entry
           b. Data Display

   SCR 3   Provide edit options for each data element:
           a. Mandatory
           b. Optional
           c. Default values
           d. Flash/Inverse
           e. Edit logic (e.g., If element1=X then
           element2 should = Y
           f. Others (explain in comments column)
           Provide input format attributes for each
   SCR 4   data element:
           a. Any text
           b. Alpha
           c. Numeric
           d. Dollar amount
           e. Time

           Allow user to compose functions by linking
           screens into fixed or variable sequences,
   SCR 5   based on edit and format rules.

           Distinguish between test versus production
   SCR 6   libraries of screens and functions.
           Allow the user to label fields on screens
           and reports consistently with user's
           terminology, without program code
   SCR 7   changes.
           Provide graphic building capabilities
   SCR 8   including:
           a. Line drawing
           b. drag-and-drop positioning of any screen
           element
           c. Images (e.g., JPEG, BMP, GIF)
           d. Font / Size
           e. Color formatting
                       FORM A
      FUNCTIONAL REQUIREMENTS
                 (SCR) Screen Builder
nter Application D Here]
nter Application E Here]
nter Application F Here]

             COMMENTS
STOM, W=WON'T BID
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                    (URG) User Report Generator
 A=        [Enter Application A Here]                               D= [Enter Application D Here]
 B=        [Enter Application B Here]                               E= [Enter Application E Here]
 C=        [Enter Application C Here]                               F= [Enter Application F Here]


 ID                    DESCRIPTION                        STATUS*         SOURCE            COMMENTS
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
                  USER REPORT GENERATOR
URG 1      Ability for appropriate employee(s) without
           programming skills to generate reports
           related to any identifier in the system.
URG 2      Provide a report writer that has the
           following features:
           a. Multiple line format
           b. Link multiple files together without
           knowledge of SQL or Boolean logic
           c. Calculate fields and print them on
           reports
           d. Detail and summary level reports
           e. Cross-tabulation/multi-dimensional
           summary reports.
           f. Line graphs
           g. Bar graphs
           h. Pie charts
           i. Forms
           j. Natural Language Interface
           k. QBE – Query By Example
           l. Dials, gauges, meters objects
           m. Print bar codes
URG 3      Create complex mix-format reports
           including two or more of the above URG.2
           report features.
URG 4      Provide syntax error editing of report
           requests, including online requests.
URG 5      Allow reporting on at least six levels of
           subtotals and totals.
URG 6      Allow custom calculations using displayed
           data, non-displayed data, and all
           subtotals/totals.
URG 7      Calculate averages, percentages, and
           totals at detail and summary levels.
URG 8      Generate cross-tabulations of matrices with
           up to three variables (A by B by C), and
           calculate subtotals and percentages for
           each cell, column, and row.
URG 9      Provide automatic paging, page
           numbering, dating, printing of headings,
           and printing of report ID.




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/URG
VENDOR     [Enter Vendor Name Here]                                                                 FORM A
                                                                                   FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                     (URG) User Report Generator
 A=        [Enter Application A Here]                                D= [Enter Application D Here]
 B=        [Enter Application B Here]                                E= [Enter Application E Here]
 C=        [Enter Application C Here]                                F= [Enter Application F Here]


 ID                     DESCRIPTION                          STATUS*       SOURCE            COMMENTS
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
URG 10     Display reports at specified terminals, and
           then forward to a specified printer, if
           desired.
URG 11     Allow sorting of data by at least six levels of
           user-defined sort keys.




                                    ce889d78-b37a-40aa-911d-6676ae69d824.xls/URG
VENDOR     [Enter Vendor Name Here]                                                                 FORM A
                                                                                   FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                     (URG) User Report Generator
 A=        [Enter Application A Here]                                D= [Enter Application D Here]
 B=        [Enter Application B Here]                                E= [Enter Application E Here]
 C=        [Enter Application C Here]                                F= [Enter Application F Here]


 ID                     DESCRIPTION                         STATUS*        SOURCE            COMMENTS
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
URG 12     Place outputs from the report generator
           into files that can be downloaded into
           popular desktop applications such as
           Excel, Word, and Access.
URG 13     Allow multiple users to view same report
           simultaneously.
URG 14     Allow selection and manipulation of data on
           a produced report (e.g. select certain
           pages to print, cut, paste, etc. via DLL)
URG 15     Allow user to schedule report generator
           requests for regular processing.
URG 16     Allow scheduling on a regular basis
           according to specified criteria (such as one
           or more times per day, weekly on specified
           day, monthly on first day of month and
           fiscal period, etc.)
URG 17     Support user-defined ad hoc reporting
           capability, allowing access to all databases
           assimilated in the online current files and in
           historical records, within the same report.

URG 18     Enable users to code complex logic
           processing and field calculations using a
           supplied 4GL procedural language
URG 19     Provide row filtering against any
           displayed/non-displayed field. Logical
           filtering to include:
           a. Included In / Not Included In
           b. Value and range checking of calculated
           values
           c. Keyword search in free-form text fields.

           d. Conditional group-by set functions (e.g.,
           include a group-by set of detail rows if the
           group-by total value of a field exceeds
           10,000). Accomplished with a single
           function, and not mulitple-pass SQL and
           joining.
URG 20     Provide complex set processing and table
           joining capabilities to include:
           a. Outer joins ( In A or B)
           b. Inner joins (In A and B)
           c. Missing merge (In A and Not in B)
           d. Detail and summary level reports



                                    ce889d78-b37a-40aa-911d-6676ae69d824.xls/URG
VENDOR     [Enter Vendor Name Here]                                                                 FORM A
                                                                                   FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                     (URG) User Report Generator
 A=        [Enter Application A Here]                                D= [Enter Application D Here]
 B=        [Enter Application B Here]                                E= [Enter Application E Here]
 C=        [Enter Application C Here]                                F= [Enter Application F Here]


 ID                     DESCRIPTION                          STATUS*       SOURCE            COMMENTS
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
           e. Include detail records only if summary
           totals meet a criteria. For example, What %
           of residential clients who stay > 9 days are
           also open in an outpatient program?
           (Please explain in comments how difficult
           this is to code/generate.)
URG 21     Provide exit points to third-party programs
           and user-defined functions (E.g., external
           Customer Scoring algorithm).

URG 22     Provide ability to interrupt, check, or cancel
           a report and view data reported to that
           point.
URG 23     Provide ability to generate reports in real
           time/online.
URG 24     Control security access, as it relates to the
           report writer, at the data element level if the
           Health Care System chooses. This
           includes access to data elements for
           calculations and/or sorts.
URG 25     Provide a graphical WEB enabled report
           generator, with appropriate security
           access, which provides the following:
URG 26     Dynamic access to the entire database
           portfolio.
URG 27     Drill-down or cross-report hot link
           capabilities from summary data into detail
           data reports.
URG 28     Support the integration of „meta-data‟
           regarding business rules, data dictionaries,
           and data content with report design
           functionalities.
URG 29     Allow the user to label fields on screens
           and reports consistently with Health Care
           System terminology, without program code
           changes.
URG 30     Support „production‟ report repositories
           that authorized users can:
           a. View on-line from a Windows
           application.
           b. View on-line from a WEB viewer.
           c. Print on demand.
           d. Email on demand
           e. Fax on demand



                                    ce889d78-b37a-40aa-911d-6676ae69d824.xls/URG
VENDOR     [Enter Vendor Name Here]                                                                FORM A
                                                                                  FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                    (URG) User Report Generator
 A=        [Enter Application A Here]                               D= [Enter Application D Here]
 B=        [Enter Application B Here]                               E= [Enter Application E Here]
 C=        [Enter Application C Here]                               F= [Enter Application F Here]


 ID                     DESCRIPTION                        STATUS*        SOURCE            COMMENTS
                                                                       (A-Z)
         *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
           f. Find desired reports through an on-line
           index of reports by subject matter.
URG 31     Allow users to copy production report
           definitions to be modified for their specific
           purposes.
URG 32     Incorporate Object Oriented technology
           that allows the creation of reports using
           objects. Object definitions might be an
           admission, a discharge, a product, or an
           HMO member.
URG 33     Supply statiscal methodologies such as:
           a. Statiscal treatment of missing values
           b. Standard Deviations
           c. Logistical regression
           d. Linear regression
           e. Decision support trees
           f. Time series
           g. Category analysis
URG 34     Allow user to dynamically format data
           elements (e.g., remove leading zeros);
           transform data (e.g., if value = "Y”, print
           “Yes”).
URG 35     Provide ability to generate reports on every
           data element including user-defined fields.

URG 36     Need archive database (for “inactive” or
           “purged” scheduling date), and
           mechanisms for writing reports from this
           database.
URG 37     Generated reports are automatically
           deleted from the system when printed after
           a predetermined amount of time.
URG 38     Reports can be selected to prevent deletion
           on a case by case basis or as defined in a
           job stream.
URG 39     Allow creation of multiple reports in one
           pass through the database.
URG 40     Allow connection to none-vendor
           databases via ODBC compliant
           connections




                                   ce889d78-b37a-40aa-911d-6676ae69d824.xls/URG
VENDOR [Enter Vendor Name Here]                                                             FORM A
                                                                           FUNCTIONAL REQUIREMENTS
APPLICATION(S) AND TOOL(S)/UTILITY(IES) SOURCES                                      (WEB) Intranet / Extranet
  A=     [Enter Application A Here]                            D= [Enter Application D Here]
  B=     [Enter Application B Here]                            E= [Enter Application E Here]
  C=     [Enter Application C Here]                            F= [Enter Application F Here]


 ID                   DESCRIPTION                         STATUS*   SOURCE             COMMENTS
                                                                     (A-F)
        *STATUS CODES: N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T, D=DIDN'T BID
WEB 1    Provide internet browser enabled user
         access to functionality of the bid application
         including:
         a. Registration
         b. Resource Scheduling
         c. Clinician access view
         d. ePrescriptions
         e. Behavioral health assessments
         f. Behavioral health outcome measure tools

         g. Incident reporting
         h. Quality assurance followup
         I. Clinical pathways and guidelines
         j. Claims processing and adjudication
         k.Online eligibility checking
         l. Service/Charge posting
         m. Report writer and delivery
         n. Other
WEB 2    Complies with all required security
         mechanisms and services as responded to
         in SEC.
WEB 3    Please indicate underlying development
         technologies:
         a. HTML
         b. Java
         c. CGI
WEB 4    Offer web-based application functionality ,
         as opposed to web-enabled access to
         legacy code, for the following.
         a. Registration
         b. Resource Scheduling
         c. Clinician access view
         d. ePrescriptions
         e. Behavioral health assessments
         f. Behavioral health outcome measure tools

         g. Incident reporting
         h. Quality assurance followup
         I. Clinical pathways and guidelines
         j. Claims processing and adjudication
         k.Online eligibility checking
        l. Service/Charge posting
        m. Report writer and delivery
        n. Other
WEB 5   Application Service Provider option for
        remote hosting of application at vendor's
        data center.
WEB 6   Support XML meta data interchange
        standard.
WEB 7   Screen building functionality as specified in
        SCR is available in the web-browser
        environment.
UIREMENTS
anet / Extranet

				
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posted:1/20/2012
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Description: Medical Records Check List document sample