742 2013 742 CMS Noridian DME 11-8-13
American Customer Satisfaction Index (ACSI) E-Government Website Customer Satisfaction Surveys
2013 742 CMS Noridian DME 2013_11-8-13.xlsx
2013 740 EFPTS Survey - 2013 U.S. NRC Survey
OMB: 1090-0008
⚠️ Notice: This form may be outdated. More recent filings and information on OMB 1090-0008 can be found here:
Document [xlsx]
Download: xlsx | pdf
Current Custom Qsts
Custom Qsts (12-6-13)
Custom Qsts (9-6-12)
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)
Overview
Current Model QstsCurrent Custom Qsts
Custom Qsts (12-6-13)
Custom Qsts (9-6-12)
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: | |||||||||
| 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 | ||||||||
| Used the Endeavor portal | |||||||||
| ACQhar0015423 | 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 | |||
| ACQhar0015424 | 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 website 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 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 (12-6-13)
| Model Instance Name: | |||||||||
| 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 | ||||||||
| Used the Endeavor portal | |||||||||
| ACQhar0015423 | 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 | |||
| ACQhar0015424 | 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 website Web site later and try again | |||||||||
| Send an email | |||||||||
| Try another website | |||||||||
| Try the CMS wWebsite | |||||||||
| 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 4: Custom Qsts (9-6-12)
| Model Instance Name: | |||||||||
| 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 5: Custom Qsts 11-19-10
Sheet 6: Custom Qsts 6-14-10
Sheet 7: Custom Qsts 3-1-10
| Model Instance Name: | |||||||||
| 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 | |||||
| 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 8: Custom Qsts 10-22-09
| Model Instance Name: | ||||||||
| 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 9: Custom Qsts 10-1-09
| Model Instance Name: | ||||||||
| 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 |
| 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 | ||||
| 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 | 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 10: Custom Qsts 06-25-09
| Model Instance Name: | ||||||||
| 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 | ||||
| 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 11: Custom Qsts (5-11-09)
| Model Instance Name: | ||||||||
| 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 | ||||||||
| 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 | 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 | ||||
| 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 | ||||||||
| 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 12: Current Custom Qsts (10-2-08)
| Model Instance Name: | ||||||||
| 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 | ||||||||
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |
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