A. Scope of Work / Requested Services Nassau Health Care Corporation (“NHCC”) seeks to procure evidence‑based, software‑based clinical decision support tools used by the Case Management and Utilization Review departments to determine appropriate patient status. The software must assist with evaluating inpatient, observation, and outpatient level‑of‑care determinations and must support regulatory compliance, payer audit defensibility, and standardized documentation. The requested software must: • Provide clinical criteria for adult, pediatric, behavioral health, and emergency department populations. • Supply evidence‑based, nationally recognized guidelines updated at least annually. • Deliver a searchable, intuitive software interface. • Support documentation and audit trails for UR and Physician Advisor review. • Provide reporting functionality and administrative dashboards. • Offer licensing for all required NHCC staff. B. Scope of Services 1. Clinical Criteria Content Requirements The system must include: • Medical and surgical criteria • Emergency department utilization criteria • Behavioral health criteria • Pediatric criteria • Procedure‑ and condition‑specific criteria 2. Functional Requirements of the Software • Searchable criteria engine • Documentation tools for level‑of‑care determinations • User activity audit trails • Role‑based access controls • Administrative dashboards and usage metrics • Exportable reports for payer audits and internal compliance 3. Technical & Integration Requirements The solution must: • Support Single Sign‑On (SSO) • Provide API or HL7 interoperability • Meet HIPAA security standards • Integrate with NHCC systems, including SCM, Eagle, Aprima, CarePort, and revenue cycle platforms 4. Implementation & Training Requirements Proposers must outline: • Implementation timeline and milestones • Staff training plan • Configuration and testing approach • Ongoing support structure 5. Support, Maintenance & Update Requirements The proposal must describe: • Annual criteria update process • Software release cycles • Help desk response standards • Escalation pathways • Disaster recovery 6. Performance Standards & KPIs Minimum KPIs: • System uptime ≥ 99.9% • Criteria updates within 30 days of release • Help desk response within 1 business day • High‑priority issue resolution within 72 hours • ≥ 90% user satisfaction 7. Compliance Requirements Vendor must demonstrate compliance with: • HIPAA standards • CMS Conditions of Participation • NYS confidentiality laws • Joint Commission requirements • NHCC internal data protection policies
