566 CMS-NAS-DME MAC Qnaire 8-22-2012

American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys

2012 566 CMS-NAS-DME MAC Qnaire 8-22-2012.xlsx

562 AHRQ Enterprise_9-10-12_UPDATED - 589 CDC SM Posting Survey

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Current Model Qsts
Current Custom Qsts
Custom Qsts 11-19-10
Custom Qsts 6-14-10
Custom Qsts 3-1-10
Custom Qsts 10-22-09
Custom Qsts 10-1-09
Custom Qsts 06-25-09
Custom Qsts (5-11-09)
Current Custom Qsts (10-2-08)


Sheet 1: Current Model Qsts

Model Instance Name:




CMS - Noridian DME MAC




MID: wYBJIxo1REpAFwEckohs0g==



Date: 11/7/2006


CMS - Noridian DME MAC MODEL QUESTION LIST
Model questions utilize the ACSI methodology to determine scores and impacts

ELEMENTS (drivers of satisfaction)
CUSTOMER SATISFACTION
FUTURE BEHAVIORS

NOTE: All questions under each element are required.
Element questions are partitioned among surveys.

Satisfaction questions are required.
Satisfaction questions appear on all surveys.

Future behaviors may be modified based on your site's objectives.
Future behavior questions appear on all surveys.







Content
(1=Poor, 10=Excellent, Don't Know)

Satisfaction
(1=Poor, 10=Excellent)

Likelihood to Return
(1=Not Very Likely, 10=Very Likely)
1 Please rate the accuracy of information on this site. 21 What is your overall satisfaction with this site? 24 How likely are you to return to this site?
2 Please rate the quality of information on this site. 22 How well does this site meet your expectations?

3 Please rate the freshness of content on this site. 23 How does this site compare to your idea of an ideal website?
Recommend
(1=Not Very Likely, 10=Very Likely)

Functionality
(1=Poor, 10=Excellent, Don't Know)


25 How likely are you to recommend this site to someone else?
4 Please rate the usefulness of the services provided on this site.



5 Please rate the convenience of the services on this site.


Primary Resource
(1=Not Very Likely, 10=Very Likely)
6 Please rate the ability to accomplish what you wanted to on this site.

26 How likely are you to use this site as your primary resource for getting information on Medicare?

Look and Feel
(1=Poor, 10=Excellent, Don't Know)




7 Please rate the ease of reading this site.

8 Please rate the clarity of site organization.
9 Please rate the clean layout of this site.

Navigation
(1=Poor, 10=Excellent, Don't Know)

10 Please rate the degree to which the number of steps it took to get where you want is acceptable.



11 Please rate the ability to find information you want on this site.



12 Please rate the clarity of the site map/directory.



13 Please rate the ease of navigation on this site.




Site Performance
(1=Poor, 10=Excellent, Don't Know)




14 Please rate the speed of loading the page on this site.



15 Please rate the consistency of speed on this site.



16 Please rate the reliability of site performance on this site.




Search
(1=Poor, 10=Excellent, Don't Know)




17 Please rate the usefulness of search results on this site.



18 Please rate how this site provides comprehensive search results.



19 Please rate the organization of search results on this site.



20 Please rate how the search feature helps you to narrow the results to find the information you want.





Sheet 2: Current Custom Qsts

Model Instance Name:

red & strike-through: DELETE





CMS - Noridian DME MAC

underlined & italicized: RE-ORDER





MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION





Date: 2/24/2010 blue + -->: REWORDING















CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions Question Label
51958
Which best describes you? Provider of medical services
Radio button, one-up vertical Single Y OPS Group Best describes you



Supplier of medical equipment or supplies








Staff of provider/supplier working primarily with billing/insurance



CMS Required


Administrative staff of a provider/supplier







Other staff of a provider/supplier







Consultant or attorney








Billing service








Other (please specify) A




7000003 A Other - which best describes you?

Text field, <100 char
N OPS Group Other-Best Describes You
CWS03909
What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Single Y OPS Group Visit Reason



Download forms








Learn of, or register for, workshops, seminars or other training events








Find contact information



CMS Required



Find general Medicare program information








Research a specific question on Medicare policy or billing








Find information on fees or fee schedules








Find out about a Local Coverage Determination (LCD)








Read Medicare publications such as newsletters, articles,etc.








Find enrollment information








Take an on-line training course








Other (please specify) A




CWS03910 A Other - primary reason?

Text field, <100 char
N OPS Group Other Visit Reason
EDO08161
How did you primarily look for information on this site today? Browsed pages by clicking links A Drop down, select one Single Y Skip Group Look for info



Searched using the site search feature B







Used the site map C




NEW A If you used the left side navigation, please tell us about your experience.

Text area, no char limit
N Skip Group Left Nav Experience
EDO08162 B What keywords did you use?

Text area, no char limit
N Skip Group Keywords
NEW C Please tell us about your experience using the site map.

Text area, no char limit
N Skip Group Site Map Experience
JKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single Y Skip Group Did you find



No E,F







I'm still searching





KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit
No Skip Group Trying to find
KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No Skip Group Do Next



Nothing, although I did not find what I wanted








Return to the Noridian Medicare Web site later and try again








Send an email








Try another website








Try the CMS Website








Write a letter








Other C




KFB04016 C Please explain what you were looking for.

Text area, no char limit
No Skip Group Other-Looking For
CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single Y
Medicare Contract



Other





51957
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Single Y
Visit Frequency



Once or twice



CMS Required



Three or four times








More than once per week but not every day








Every day





JKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single Y OPS Group Visit Driver



Email from CMS / Noridian








Prior experience with CMS / Noridian








Remittance Advice/Noridian Letter








Peer or Association Referral








Search engine








Noridian customer service representative








Other (please specify) D




MMM00419 D Other - led you to visit this site

Text field, <100 char
N OPS Group Other-Visit Driver
51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit
N
open-Improvement
JKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes - I am a member of the Noridian Medicare electronic mailing list
Radio button, one-up vertical Single Y
Mailing List



Yes - Someone in my office is a member








No - I choose not to be part of Noridian Medicare's electronic mailing list








No - please supply me with the link to the subscription page upon survey completion





CWS02767
If you are over the age of 18 and would like Noridian Administrative Services (NAS) to respond to your feedback regarding this website, please provide your email address here.

Text field, <100 char
N
Feedback Email


















































































Sheet 3: Custom Qsts 11-19-10

Model Instance Name:

red & strike-through: DELETE





CMS - Noridian DME MAC

underlined & italicized: RE-ORDER





MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION





Date: 2/24/2010 blue + -->: REWORDING















CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
51958
Jyotsna.Bisaro: Required of CMS contractors Which best describes you? Provider of medical services
Radio buttons select one Y OPS Group



Supplier of medical equipment or supplies








Staff of provider/supplier working primarily with billing/insurance








Administrative staff of a provider/supplier







Other staff of a provider/supplier







Consultant or attorney








Billing service








Other (please specify) A




7000003 A Other - which best describes you?

Text field
No OPS Group
CWS03909
Jyotsna.Bisaro: Required of CMS contractors What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio buttons select one Y OPS Group Visit Reason


Download forms



Learn of, or register for, workshops, seminars or other training events



Find contact information



Find general Medicare program information



Research a specific question on Medicare policy or billing



Find information on fees or fee schedules



Find out about a Local Coverage Determination (LCD)



Read Medicare publications such as newsletters, articles,etc.



Find enrollment information



Take an on-line training course



Other (please specify) SKIP B
CWS03910 SKIP B Other - primary reason?



No OPS Group Other Visit Reason
MMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links E Drop down, select one Single Y




Searched using the site search feature D







Used the site map E




EDO08161
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single Y




Searched using the site search feature D







Used the site map





EDO08162 D What keywords did you use?

Text area, no char limit s N

JKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single Y If this, then CJKR00234



No E,F


If this, then KFB04015



I'm still searching



If this, then CJKR00234
KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open No

KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No




Nothing, although I did not find what I wanted








Return to the Noridian Medicare Web site later and try again








Send an email








Try another website








Try the CMS Website








Write a letter








Other C




KFB04016 C Please explain what you were looking for.

Text area, no char limit Open No

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single Y




Other





51957
Jyotsna.Bisaro: Required of CMS contractors In the last 30 days, how many times have you visited this website? This is my first time
Radio Button Single Y select one



Once or twice








Three or four times








More than once per week but not every day








Every day





JKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single Y




Email from CMS / Noridian








Prior experience with CMS / Noridian








Remittance Advice/Noridian Letter








Peer or Association Referral








Search engine








Noridian customer service representative








Other (please specify) D




MMM00419 D Other - led you to visit this site

Text field, <100 char Open N

51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open N

JKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes - I am a member of the Noridian Medicare electronic mailing list
Radio button, one-up vertical Single Y




Yes - Someone in my office is a member








No - I choose not to be part of Noridian Medicare's electronic mailing list








No - please supply me with the link to the subscription page upon survey completion





CWS02767
From time to time, Noridian Administrative Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address. If you are over the age of 18 and would like Noridian Administrative Services (NAS) to respond to your feedback regarding this website, please provide your email address here.

Text field, <100 char OPEN N













Sheet 4: Custom Qsts 6-14-10

Model Instance Name:

red & strike-through: DELETE





CMS - Noridian DME MAC

underlined & italicized: RE-ORDER





MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION





Date: 2/24/2010 blue + -->: REWORDING















CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
51958
Jyotsna.Bisaro: Required of CMS contractors Which best describes you? Provider of medical services
Radio buttons select one Y OPS Group



Supplier of medical equipment or supplies








Staff of provider/supplier working primarily with billing/insurance








Administrative staff of a provider/supplier







Other staff of a provider/supplier







Consultant or attorney








Billing service








Other (please specify) A




7000003 A Other - which best describes you?

Text field
No OPS Group
CWS03909
Jyotsna.Bisaro: Required of CMS contractors What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio buttons select one Y OPS Group Visit Reason


Download forms



Learn of, or register for, workshops, seminars or other training events



Find contact information



Find general Medicare program information



Research a specific question on Medicare policy or billing



Find information on fees or fee schedules



Find out about a Local Coverage Determination (LCD)



Read Medicare publications such as newsletters, articles,etc.



Find enrollment information



Take an on-line training course



Other (please specify) SKIP B
CWS03910 SKIP B Other - primary reason?



No OPS Group Other Visit Reason
MMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single Y




Searched using the site search feature








Used the site map





JKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single Y




No E, F







I'm still searching





KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open No

KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No




Nothing, although I did not find what I wanted








Return to the Noridian Medicare Web site later and try again








Send an email








Try another website








Try the CMS Website








Write a letter








Other C




KFB04016 C Please explain what you were looking for.

Text area, no char limit Open No

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single Y




Other





C5839
Which state do you reside in? Not applicable
Drop down, select one Single Y




Alabama








Alaska








Arizona








Arkansas








California








Colorado








Connecticut








Delaware








Florida








Georgia








Hawaii








Idaho








Illinois








Indiana








Iowa








Kansas








Kentucky








Louisiana








Maine








Maryland








Massachusetts








Michigan








Minnesota








Mississippi








Missouri








Montana








Nebraska








Nevada








New Hampshire








New Jersey








New Mexico








New York








North Carolina








North Dakota








Ohio








Oklahoma








Oregon








Pennsylvania








Rhode Island








South Carolina








South Dakota








Tennessee








Texas








Utah








Vermont








Virginia








Washington








Washington D.C.








West Virginia








Wisconsin








Wyoming








American Samoa








Guam








Northern Mariana Islands








Saipan








Other





51957
Jyotsna.Bisaro: Required of CMS contractors In the last 30 days, how many times have you visited this website? This is my first time
Radio Button Single Y select one



Once or twice








Three or four times








More than once per week but not every day








Every day





JKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single Y




Email from CMS / Noridian








Prior experience with CMS / Noridian








Remittance Advice/Noridian Letter








Peer or Association Referral








Search engine








Noridian customer service representative








Other (please specify) D




MMM00419 D Other - led you to visit this site

Text field, <100 char Open N

51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open N

JKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single Y




No








I wasn't aware that Noridian Medicare had a mailing list








Yes - I am a member of the Noridian Medicare electronic mailing list








Yes - Someone in my office is a member








No - I choose not to be part of Noridian Medicare's electronic mailing list








No - please supply me with the link to the subscription page upon survey completion





CWS02767
From time to time, Noridian Administrative Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.

Text field, <100 char OPEN N



Sheet 5: Custom Qsts 3-1-10

Model Instance Name:

red & strike-through: DELETE





CMS - Noridian DME MAC

underlined & italicized: RE-ORDER





MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION





Date: 2/24/2010 blue + -->: REWORDING















CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
51958
Which best describes you? Provider of medical services
Radio buttons select one Y OPS Group



Supplier of medical equipment or supplies








Staff of provider/supplier working primarily with billing/insurance








Administrative staff of a provider/supplier







Other staff of a provider/supplier







Consultant or attorney








Billing service








Other (please specify) A




7000003 A Other - which best describes you?

Text field

OPS Group
51960
What is your primary reason for visiting this site today? Download forms
Radio buttons select one Y OPS Group

Learn of, or register for, workshops, seminars or other training events


Find contact information


Find general Medicare program information


Research a specific question on Medicare policy or billing


Find information on fees or fee schedules


Find out about a Local Coverage Determination (LCD)


Read Medicare publications such as newsletters, articles,etc.


Find enrollment information


Take an on-line training course


Other (please specify) B
7000004 B Other - primary reason?




OPS Group
NEW
What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio buttons select one Y OPS Group Visit Reason

Download forms


Learn of, or register for, workshops, seminars or other training events


Find contact information


Find general Medicare program information


Research a specific question on Medicare policy or billing


Find information on fees or fee schedules


Find out about a Local Coverage Determination (LCD)


Read Medicare publications such as newsletters, articles,etc.


Find enrollment information


Take an on-line training course


Other (please specify) SKIP B
NEW SKIP B Other - primary reason?




OPS Group Other Visit Reason
MMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single





Searched using the site search feature








Used the site map





JKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single





No E, F







I'm still searching





KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open


KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No




Nothing, although I did not find what I wanted








Return to the Noridian Medicare Web site later and try again








Send an email








Try another website








Try the CMS Website








Write a letter








Other C




KFB04016 C Please explain what you were looking for.

Text area, no char limit Open


CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single





Other





C5839
Which state do you reside in? Not applicable
Drop down, select one Single





Alabama








Alaska








Arizona








Arkansas








California








Colorado








Connecticut








Delaware








Florida








Georgia








Hawaii








Idaho








Illinois








Indiana








Iowa








Kansas








Kentucky








Louisiana








Maine








Maryland








Massachusetts








Michigan








Minnesota








Mississippi








Missouri








Montana








Nebraska








Nevada








New Hampshire








New Jersey








New Mexico








New York








North Carolina








North Dakota








Ohio








Oklahoma








Oregon








Pennsylvania








Rhode Island








South Carolina








South Dakota








Tennessee








Texas








Utah








Vermont








Virginia








Washington








Washington D.C.








West Virginia








Wisconsin








Wyoming








American Samoa








Guam








Northern Mariana Islands








Saipan








Other





51957
In the last 30 days, how many times have you visited this website? This is my first time
Radio Button Single Y select one



Once or twice








Three or four times








More than once per week but not every day








Every day





JKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single





Email from CMS / Noridian








Prior experience with CMS / Noridian








Remittance Advice/Noridian Letter








Peer or Association Referral








Search engine








Noridian customer service representative








Other (please specify) D




MMM00419 D Other - led you to visit this site

Text field, <100 char Open


51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open


JKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single





No








I wasn't aware that Noridian Medicare had a mailing list








Yes - I am a member of the Noridian Medicare electronic mailing list








Yes - Someone in my office is a member








No - I choose not to be part of Noridian Medicare's electronic mailing list








No - please supply me with the link to the subscription page upon survey completion





CWS02767
From time to time, Noridian Administrative Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.

Text field, <100 char OPEN N



Sheet 6: Custom Qsts 10-22-09

Model Instance Name:

red & strike-through: DELETE




CMS - Noridian DME MAC

underlined & italicized: RE-ORDER




MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION




Date: 5/12/2009 blue + -->: REWORDING













CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
51958
Which best describes you? Provider of medical services
Radio buttons select one Y OPS Group



Supplier of medical equipment or supplies







Staff of provider/supplier working primarily with billing/insurance







Administrative staff of a provider/supplier






Other staff of a provider/supplier






Consultant or attorney







Billing service







Other (please specify) A



7000003 A Other - which best describes you?

Text field

OPS Group
51960
What is your primary reason for visiting this site today? Download forms
Radio buttons select one Y OPS Group



Learn of, or register for, workshops, seminars or other training events







Find contact information







Find general Medicare program information







Research a specific question on Medicare policy or billing







Find information on fees or fee schedules







Find out about a Local Coverage Determination (LCD)







Read Medicare publications such as newsletters, articles, etc.







Find enrollment information







Take an on-line training course







Other (please specify) B



7000004 B Other - primary reason?

Text field

OPS Group
MMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single




Searched using the site search feature







Used the site map




JKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single




No E, F






I'm still searching




KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open

KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No


Nothing, although I did not find what I wanted







Return to the Noridian Medicare Web site later and try again







Send an email







Try another website







Try the CMS Website







Write a letter







Other C



KFB04016 C Please explain what you were looking for.

Text area, no char limit Open

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single




Other




C5839
Which state do you reside in? Not applicable
Drop down, select one Single




Alabama







Alaska







Arizona







Arkansas







California







Colorado







Connecticut







Delaware







Florida







Georgia







Hawaii







Idaho







Illinois







Indiana







Iowa







Kansas







Kentucky







Louisiana







Maine







Maryland







Massachusetts







Michigan







Minnesota







Mississippi







Missouri







Montana







Nebraska







Nevada







New Hampshire







New Jersey







New Mexico







New York







North Carolina







North Dakota







Ohio







Oklahoma







Oregon







Pennsylvania







Rhode Island







South Carolina







South Dakota







Tennessee







Texas







Utah







Vermont







Virginia







Washington







Washington D.C.







West Virginia







Wisconsin







Wyoming







American Samoa







Guam







Northern Mariana Islands







Saipan







Other




51957
In the last 30 days, how many times have you visited this website? This is my first time
Radio Button Single Y select one



Once or twice







Three or four times







More than once per week but not every day







Every day




JKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single




Email from CMS / Noridian







Prior experience with CMS / Noridian







Remittance Advice/Noridian Letter







Peer or Association Referral







Search engine







Noridian customer service representative







Other (please specify) D



MMM00419 D Other - led you to visit this site

Text field, <100 char Open

51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open

JKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single




No







I wasn't aware that Noridian Medicare had a mailing list







Yes - I am a member of the Noridian Medicare electronic mailing list







Yes - Someone in my office is a member







No - I choose not to be part of Noridian Medicare's electronic mailing list







No - please supply me with the link to the subscription page upon survey completion






From time to time, Noridian Administrative Services likes to reach out to website visitors to learn more about their experiences using the website. If you are over the age of 18 and would be willing to be contacted in the future, please provide your email address.

Text field, <100 char OPEN N


Sheet 7: Custom Qsts 10-1-09

Model Instance Name:

red & strike-through: DELETE




CMS - Noridian DME MAC

underlined & italicized: RE-ORDER




MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION




Date: 5/12/2009 blue + -->: REWORDING













CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
CJKR00232
Which best describes you? Billing or administrative staff for supplier
Radio button, one-up vertical Single




Supplier







Administrative staff of a supplier







Other staff of a supplier







Billing service







Consultant or attorney







Local, state, or federal government employee or contractor







Other health care insurer or agency







Other (please specify) A



CJKR00233 A Other Which best describes you

Text field, <100 char Open

C51958
Which best describes you? Provider of medical services
Radio buttons select one Y OPS Group
Supplier of medical equipment or supplies
Staff of provider/supplier working primarily with billing/insurance
Administrative staff of a provider/supplier
Other staff of a provider/supplier
Consultant or attorney
Billing service
Other (please specify) SKIP A
C7000003 SKIP A Other - which best describes you?

Text field

OPS Group
CJKR00235
What is your primary reason for visiting this site today? Download forms
Radio button, one-up vertical Single




Find contact information







Find enrollment information







Find general Medicare program information







Find information on fees or fee schedules







Find out about a Local Coverage Determination







Learn of, or register for, workshops, seminars or other training events







Read Medicare publications such as newsletters, press releases, etc.







Research a specific question on Medicare policy or billing







Take an on-line training course







Other (please specify) B



CJKR00237 B Other Primary reason for visit

Text field, <100 char Open

C51960
What is your primary reason for visiting this site today? Download forms
Radio buttons select one Y OPS Group
Learn of, or register for, workshops, seminars or other training events
Find contact information
Find general Medicare program information
Research a specific question on Medicare policy or billing
Find information on fees or fee schedules
Find out about a Local Coverage Determination (LCD)
Read Medicare publications such as newsletters, articles, etc.
Find enrollment information
Take an on-line training course
Other (please specify) SKIP B
C7000004 SKIP B Other - primary reason?

Text field

OPS Group
CMMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single




Searched using the site search feature







Used the site map




CJKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single




No E, F






I'm still searching




KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open

KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No


Nothing, although I did not find what I wanted







Return to the Noridian Medicare Web site later and try again







Send an email







Try another website







Try the CMS Website







Write a letter







Other C



KFB04016 C Please explain what you were looking for.

Text area, no char limit Open

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single




Other




C5839
Which state do you reside in? Not applicable
Drop down, select one Single




Alabama







Alaska







Arizona







Arkansas







California







Colorado







Connecticut







Delaware







Florida







Georgia







Hawaii







Idaho







Illinois







Indiana







Iowa







Kansas







Kentucky







Louisiana







Maine







Maryland







Massachusetts







Michigan







Minnesota







Mississippi







Missouri







Montana







Nebraska







Nevada







New Hampshire







New Jersey







New Mexico







New York







North Carolina







North Dakota







Ohio







Oklahoma







Oregon







Pennsylvania







Rhode Island







South Carolina







South Dakota







Tennessee







Texas







Utah







Vermont







Virginia







Washington







Washington D.C.







West Virginia







Wisconsin







Wyoming







American Samoa







Guam







Northern Mariana Islands







Saipan







Other




C51957
In the last 30 days, how many times have you visited this website? This is my first time

Drop-down menu
Radio buttons
Y select one
Once or twice before
Three or four times before
More than once per week but not every day
Every day
CJKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single




Email from CMS / Noridian







Prior experience with CMS / Noridian







Remittance Advice/Noridian Letter







Peer or Association Referral







Search engine







Noridian customer service representative







Other (please specify) D



CMMM00419 D Other - led you to visit this site

Text field, <100 char Open

C51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open

CJKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single




No







I wasn't aware that Noridian Medicare had a mailing list







Yes - I am a member of the Noridian Medicare electronic mailing list







Yes - Someone in my office is a member







No - I choose not to be part of Noridian Medicare's electronic mailing list







No - please supply me with the link to the subscription page upon survey completion






Sheet 8: Custom Qsts 06-25-09

Model Instance Name:

red & strike-through: DELETE




CMS - Noridian DME MAC

underlined & italicized: RE-ORDER




MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION




Date: 5/12/2009 blue + -->: REWORDING













CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
CJKR00232
Which best describes you? Billing or administrative staff for supplier
Radio button, one-up vertical Single




Supplier







Staff of provider/supplier working primarily with billing/insurance







Administrative staff of a supplier







Other staff of a supplier







Billing service







Consultant or attorney







Local, state, or federal government employee or contractor







Other health care insurer or agency







Other (please specify) A



CJKR00233 A Other Which best describes you

Text field, <100 char Open

CJKR00235
What is your primary reason for visiting this site today? Download forms
Radio button, one-up vertical Single




Find contact information







Find enrollment information







Find general Medicare program information







Find information on fees or fee schedules







Find out about a Local Coverage Determination







Learn of, or register for, workshops, seminars or other training events







Read Medicare publications such as newsletters, press releases, etc.







Research a specific question on Medicare policy or billing







Take an on-line training course







Other (please specify) B



CJKR00237 B Other Primary reason for visit

Text field, <100 char Open

CMMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single




Searched using the site search feature







Used the site map




CJKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single




No E, F






I'm still searching




KFB04014 E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open

KFB04015 F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No


Nothing, although I did not find what I wanted







Return to the Noridian Medicare Web site later and try again







Send an email







Try another website







Try the CMS Website







Write a letter







Other C



KFB04016 C Please explain what you were looking for.

Text area, no char limit Open

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single




Other




C5839
Which state do you reside in? Not applicable
Drop down, select one Single




Alabama







Alaska







Arizona







Arkansas







California







Colorado







Connecticut







Delaware







Florida







Georgia







Hawaii







Idaho







Illinois







Indiana







Iowa







Kansas







Kentucky







Louisiana







Maine







Maryland







Massachusetts







Michigan







Minnesota







Mississippi







Missouri







Montana







Nebraska







Nevada







New Hampshire







New Jersey







New Mexico







New York







North Carolina







North Dakota







Ohio







Oklahoma







Oregon







Pennsylvania







Rhode Island







South Carolina







South Dakota







Tennessee







Texas







Utah







Vermont







Virginia







Washington







Washington D.C.







West Virginia







Wisconsin







Wyoming







American Samoa







Guam







Northern Mariana Islands







Saipan







Other




C51957
In the last 30 days, how many times have you visited this Web site? This is my first time
Radio button, one-up vertical Single




Once or twice before







Three or four times before







More than once per week but not every day







Every day




CJKR00236
What led you to visit this site? New supplier to Noridian
Radio button, one-up vertical Single




Email from CMS / Noridian







Prior experience with CMS / Noridian







Remittance Advice/Noridian Letter







Peer or Association Referral







Search engine







Noridian customer service representative







Other (please specify) D



CMMM00419 D Other - led you to visit this site

Text field, <100 char Open

C51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open

CJKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single




No







I wasn't aware that Noridian Medicare had a mailing list







Yes - I am a member of the Noridian Medicare electronic mailing list







Yes - Someone in my office is a member







No - I choose not to be part of Noridian Medicare's electronic mailing list







No - please supply me with the link to the subscription page upon survey completion





Sheet 9: Custom Qsts (5-11-09)

Model Instance Name:

red & strike-through: DELETE




CMS - Noridian DME MAC

underlined & italicized: RE-ORDER




MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION




Date: 5/11/2009 blue + -->: REWORDING













CMS - Noridian DME MAC CUSTOM QUESTION LIST
CQID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
CJKR00232
Which best describes you? Billing or administrative staff for supplier
Radio button, one-up vertical Single




Supplier







Staff of provider/supplier working primarily with billing/insurance







Administrative staff of a supplier







Other staff of a supplier







Billing service







Clearinghouse







Consultant or attorney







Local, state, or federal government employee or contractor







EDI software vendor







Other health care insurer or agency







Other (please specify) A



CJKR00233 A Other Which best describes you

Text field, <100 char Open

CJKR00235
What is your primary reason for visiting this site today? Download forms
Radio button, one-up vertical Single




Find contact information







Find enrollment information







Find general Medicare program information







Find information on fees or fee schedules







Find out about a Local Coverage Determination







Learn of, or register for, workshops, seminars or other training events







Read Medicare publications such as newsletters, press releases, etc.







Research a specific question on Medicare policy or billing







Take an on-line training course







Other (please specify) B



CJKR00237 B Other Primary reason for visit

Text field, <100 char Open

CMMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single




Searched using the site search feature







Used the site map




CJKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single




No SKIP E, F






I'm still searching




NEW SKIP E Please tell us what you were trying to do or find on the website.

Text area, no char limit Open

NEW SKIP F What will you do next? Call the Noridian Medicare call center
Radio button, one-up vertical Single No


Nothing, although I did not find what I wanted







Return to the Noridian Medicare Web site later and try again







Send an email







Try another website







Try the CMS Website







Write a letter







Other C



NEW C Please explain what you were looking for.

Text field, <100 char Open

CJKR00077
If you did not find what you were looking for, what will you do next? Not applicable; I found/completed what I wanted
Radio button, one-up vertical Single




Nothing, although I did not find/complete what I wanted







Call the Noridian Medicare call center







Return to the Noridian Medicare Web site later and try again







Send an email







Write a letter







Try another website







Try the CMS Website







Other (please specify) C



CJKR00078 C Other did you find what you were looking for

Text field, <100 char Open

CJKR00010
If you were not able to accomplish your goal in visiting this site today, please tell us what you were trying to do or find:

Text area, no char limit Open

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single




Other




C5839
Which state do you reside in? Not applicable
Drop down, select one Single




Alabama







Alaska







Arizona







Arkansas







California







Colorado







Conecticut Connecticut







Delaware







Florida







Georgia







Hawaii







Idaho







Illinois







Indiana







Iowa







Kansas







Kentucky







Louisiana







Maine







Maryland







Massachusetts







Michigan







Minnesota







Mississippi







Missouri







Montana







Nebraska







Nevada







New Hampshire







New Jersey







New Mexico







New York







North Carolina







North Dakota







Ohio







Oklahoma







Oregon







Pennsylvania







Rhode Island







South Carolina







South Dakota







Tennessee







Texas







Utah







Vermont







Virginia







Washington







Washington D.C.







West Virginia







Wisconsin







Wyoming







American Somoa Samoa







Guam







Northern Mariana Islands







Saipan







Other




C51957
In the last 30 days, how many times have you visited this Web site? This is my first time
Radio button, one-up vertical Single




Once or twice before







Three or four times before







More than once per week but not every day







Every day




CJKR00236
What led you to visit this site? Mailing list
Radio button, one-up vertical Single




Email from CMS / Noridian







Web advertisement







Prior experience with CMS / Noridian







Recommendation from a friend/family member/colleague







Search engine







New supplier to Noridian







Remittance Advice/Noridian Letter







Peer or Association Referral







Noridian customer service representative







Other (please specify) D



CMMM00419 D Other - led you to visit this site

Text field, <100 char Open

C51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open

CJKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single




No







I wasn't aware that Noridian Medicare had a mailing list







Yes - I am a member of the Noridian Medicare electronic mailing list







Yes - Someone in my office is a member







No - I choose not to be part of Noridian Medicare's electronic mailing list







No - please supply me with the link to the subscription page upon survey completion





Sheet 10: Current Custom Qsts (10-2-08)

Model Instance Name:

red & strike-through: DELETE




CMS - Noridian DME MAC

underlined & italicized: RE-ORDER




MID: wYBJIxo1REpAFwEckohs0g==
pink: ADDITION




Date: 10/2/2008 blue + -->: REWORDING













CMS - Noridian DME MAC CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Single or Multi Required
Y/N
Special Instructions
CJKR00232
Which best describes you? Billing or administrative staff for supplier
Radio button, one-up vertical Single




Supplier







Staff of provider/supplier working primarily with billing/insurance







Administrative staff of a supplier







Other staff of a supplier







Billing service







Clearinghouse







Consultant or attorney







Local, state, or federal government employee or contractor







EDI software vendor







Other health care insurer or agency







Other (please specify) A



CJKR00233 A Other Which best describes you

Text field, <100 char Open

CJKR00235
What is your primary reason for visiting this site today? Download forms
Radio button, one-up vertical Single




Find contact information







Find enrollment information







Find general Medicare program information







Find information on fees or fee schedules







Find out about a Local Coverage Determination







Learn of, or register for, workshops, seminars or other training events







Read Medicare publications such as newsletters, press releases, etc.







Research a specific question on Medicare policy or billing







Take an on-line training course







Other (please specify) B



CJKR00237 B Other Primary reason for visit

Text field, <100 char Open

CMMM00395
How did you primarily look for information on this site today? Browsed pages by clicking links
Drop down, select one Single




Searched using the site search feature







Used the site map




CJKR00175
Did you find what you were looking for? Yes
Radio button, one-up vertical Single




No







I'm still searching




CJKR00077
If you did not find what you were looking for, what will you do next? Not applicable; I found/completed what I wanted
Radio button, one-up vertical Single




Nothing, although I did not find/complete what I wanted







Call the Noridian Medicare call center







Return to the Noridian Medicare Web site later and try again







Send an email







Write a letter







Try another website







Try the CMS Website







Other (please specify) C



CJKR00078 C Other did you find what you were looking for

Text field, <100 char Open

CJKR00010
If you were not able to accomplish your goal in visiting this site today, please tell us what you were trying to do or find:

Text area, no char limit Open

CJKR00234
Which best describes your Medicare contract of interest? DME MAC
Drop down, select one Single




Other




C5839
Which state do you reside in? Not applicable
Drop down, select one Single




Alabama







Alaska







Arizona







Arkansas







California







Colorado







Conecticut







Delaware







Florida







Georgia







Hawaii







Idaho







Illinois







Indiana







Iowa







Kansas







Kentucky







Louisiana







Maine







Maryland







Massachusetts







Michigan







Minnesota







Mississippi







Missouri







Montana







Nebraska







Nevada







New Hampshire







New Jersey







New Mexico







New York







North Carolina







North Dakota







Ohio







Oklahoma







Oregon







Pennsylvania







Rhode Island







South Carolina







South Dakota







Tennessee







Texas







Utah







Vermont







Virginia







Washington







Washington D.C.







West Virginia







Wisconsin







Wyoming







American Somoa







Guam







Northern Mariana Islands







Saipan







Other




C51957
In the last 30 days, how many times have you visited this Web site? This is my first time
Radio button, one-up vertical Single




Once or twice before







Three or four times before







More than once per week but not every day







Every day




CJKR00236
What led you to visit this site? Mailing list
Radio button, one-up vertical Single




Email from CMS / Noridian







Web advertisement







Prior experience with CMS / Noridian







Recommendation from a friend/family member/colleague







Search engine







New supplier to Noridian







Remittance Advice/Noridian Letter







Peer or Association Referral







Other (please specify) D



CMMM00419 D Other - led you to visit this site

Text field, <100 char Open

C51965
If you could identify one improvement to the Web site, what would that improvement be?

Text area, no char limit Open

CJKR00076
Are you part of the Noridian Medicare electronic mailing list? Yes
Radio button, one-up vertical Single




No







I wasn't aware that Noridian Medicare had a mailing list







Yes - I am a member of the Noridian Medicare electronic mailing list







Yes - Someone in my office is a member







No - I choose not to be part of Noridian Medicare's electronic mailing list







No - please supply me with the link to the subscription page upon survey completion




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