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TPA & Payors Satisfaction Survey

Name
Email
Phone
Overall Satisfaction
1-very satisfied 5-very dissatisfied
Overall, how satisfied are you with the 4MOST Health Network?
1  2  3  4  5
Impression of the Network
1-very satisfied 5-very dissatisfied
How satisfied are you with the geographical access of the 4MOST Health Network?
1  2  3  4  5
What service area(s) would you like to see improved or enhanced? (ie. State, County, City, etc..)
How satisfied are you with the complement of provider specialty types available? (ie. Orthopaedic, Dermatology, Surgery, etc..)
1  2  3  4  5
What provider specialty types would you like to see added or enhanced? (ie. Othtopaedic, Dermatology, Surgery, etc..)
Access Fees
1-very satisfied 5-very dissatisfied
How satisfied are you with the access fee in relation to network access & provider specialty type coverage?
1  2  3  4  5
Do you feel the current 4MOST market would bear a rate increase?
Yes  No
If yes, what would be a reasonable increase or range?
Do you feel 4MOST's access fees are comparable to its competitors?
Yes  No
Your 4MOST Sales & Service Representatives
1-very satisfied 5-very dissatisfied
Overall, how satisfied are you with your sales representative?
1  2  3  4  5
Please rate the following:
My 4MOST Sales & Service Representative,
is sincere & honest in dealing with you
1  2  3  4  5
is considerate of your time
1  2  3  4  5
is knowledgeable of the product features and benefits
1  2  3  4  5
has fulfilled all commitments made to you
1  2  3  4  5
Please rate the following:
My 4MOST Customer Service Representative,
is sincere & honest in dealing with you
1  2  3  4  5
is considerate of your time
1  2  3  4  5
is knowledgeable of the product features and benefits
1  2  3  4  5
has fulfilled all commitments made to you
1  2  3  4  5
Implementation Process
1-very satisfied 5-very dissatisfied
How satisfied are you with the current 4MOST implementation process?
1  2  3  4  5
4MOST directories are received in a timely manner
1  2  3  4  5
Provider File Distribution (if applicable)
Full-file received in a timely manner
1  2  3  4  5
Full-file received in a user friendly format with clear loading instructions
1  2  3  4  5
Ongoing monthly additions & deletions are received in a timley manner
1  2  3  4  5
Ongoing monthly additions & deletions are received in a user friendly format with clear loading instructions?
1  2  3  4  5
Claims Repricing (if applicable)
1-very satisfied 5-very dissatisfied
How satisfied are you with:
the 4MOST turn-around time for repriced claims?
1  2  3  4  5
the accuracy of 4MOST repriced claims?
1  2  3  4  5
repricing issues being resolved quickly?
1  2  3  4  5
Marketing
1-very satisfied 5-very dissatisfied
How satisfied are you with the 4MOST quarterly directory updates?
1  2  3  4  5
How satisfied are you with www.4most.com? 1  2  3  4  5
How satisfied are you with the 4MOST PPO Education Brochure? 1  2  3  4  5
What other marketing material(s) do you feel would be helpful?
Do you feel that 4MOST is widely used & recognizable?
Yes  No
Additional Comments:
  

 
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