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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
8dbd40ed-e9d4-4915-b5de-08c131700871.xls KSA
SCVHHS Behavioral Health
Functional Requirements - CONFIDENTIAL
April 2001
8dbd40ed-e9d4-4915-b5de-08c131700871.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
PRE.5 at 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
PRE.8 of 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
PRE.14 services) 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
PRE.22 and 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
PRE.24 Family is 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
PRE.27 SCVHHS 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
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
MED 12 Logs, 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
MED 18 client 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),
MED 32 as 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
MED 39 purposes 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
MED 45 all 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
MED 48 review 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
MED 50 and 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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
PAM 11 Transfer accounts and messages through an online
mailbox facility.
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
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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
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
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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:
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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).
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
PAM 80 Provide automatic insurance prorations and
coordination of benefits of up to a minimum of four
insurances based on user-specified algorithms.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.).
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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
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,
PCM 16 revenues, 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
PCM 26
across contracts and to regional averages.
Provide comparative pricing data regional and
PCM 27 state 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,
CAM 10 semiannual, 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
CAM 15
the 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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
MEE 17 Provide for transferring of enrollment data to a
PC for independent processing.
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
ART 26 Multiple services are allowed per referral
request.
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
gross payments based on past patient mix,
CMN 4
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, medical loss, claim rejections and
CMN 14
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
CMN 24
across contracts and to regional averages.
Provide comparative pricing data regional and
CMN 25 state 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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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
8dbd40ed-e9d4-4915-b5de-08c131700871.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
8dbd40ed-e9d4-4915-b5de-08c131700871.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 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.
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:
8dbd40ed-e9d4-4915-b5de-08c131700871.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. 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
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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 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:
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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 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.
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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 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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
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
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
ID DESCRIPTION STATUS* SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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:
ID DESCRIPTION STATUS* SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
Note
was being taught clients and level of
understanding
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.
ID DESCRIPTION STATUS* SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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
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
ID DESCRIPTION STATUS* SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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
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.
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
OEM 37 Permit inquiry into the exact status of all
orders, by client (e.g., ordered, verified,
canceled, preliminary report, or final
report).
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.
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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
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
ID DESCRIPTION STATUS* SOURCE
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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.
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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)
8dbd40ed-e9d4-4915-b5de-08c131700871.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
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
ID DESCRIPTION STATUS* SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
RES 44 Print or display (at user's option) a list of
scheduled patients by service area and
time 24 hours in advance.
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).
ID DESCRIPTION STATUS* SOURCE COMMENTS
*STATUS CODES:N=NOW, S=SOON, F=FUTURE, U=USER MODIFIES, C=CUSTOM, W=WON'T BID
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.
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
8dbd40ed-e9d4-4915-b5de-08c131700871.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
8dbd40ed-e9d4-4915-b5de-08c131700871.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
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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
INC 2 or 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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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).
8dbd40ed-e9d4-4915-b5de-08c131700871.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 22 Users can be connected to a group and
gain resource access at the group level.
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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)
8dbd40ed-e9d4-4915-b5de-08c131700871.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
d. Detail and summary level reports
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.
8dbd40ed-e9d4-4915-b5de-08c131700871.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
d. Email on demand
e. Fax on demand
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
8dbd40ed-e9d4-4915-b5de-08c131700871.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
8dbd40ed-e9d4-4915-b5de-08c131700871.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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