Form #3 Form #3 Health Plan Information

Attachment B-1. Data Submission Secure Web Site and Information Collection Forms Screen Shots

Figure 1. Public/Login or Registration Page – Provides submission information and a link for users to register or log in if they have received their user name and password.

Figure 2 Registration - Participants are requested to enter their contact information, identify their role, as a sponsor, coalition, health plan or vendor, primary contact, if their organization previously participated in the CAHPS Health Plan database, and if also submit data to NCQA. Based on this information, the database submission administrator approves their registration to the database and automatically sends emails with their username and password.

Figure 3. Home Page. Outlines each of the steps for data submission process.

Figure 4. Health Plan Information – Users add and edit information for each health plan.

Figure 5. Submit Questionnaire - Users upload questionnaire documents in MS Word (doc) or Adobe Acrobat (pdf) format and link the uploaded document to one or more of the health plans identified in the Health Plan Information screen.

Figure 6. Submit Data File Page – Users upload data files from their local computer. Uploaded files will be evaluated in real-time to ensure they meet the basic required format. If not, users receive immediate feedback. If the file is acceptable, the data file is loaded it to the database.

Figure 7. View Submission Status – Users can view the status of their account at any time during the submission process for all health plans in their account.

5