Form 002 2018 002 Q_PalmettoGBA_JJ_Web_Browse_20180108

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Overview

Attributes
Welcome and Thank You Text
Model Qsts
Current CQs
Types

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Sheet 1: Attributes

Attribute	Value
Channel	Web
Touchpoint Name	Browse
Hierarchy	No
Model Type	Desktop Browse
Journey Phase	Consideration
Touchpoint Type	Standard
Partner Involved	No
Replay	Yes
Version Number of Model Template	17.3.Y

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Sheet 2: Welcome and Thank You Text

Welcome and Thank You Text
	Welcome Text
	Thank you for visiting Palmetto GBA JM. You have been randomly selected to take part in this survey that is being conducted by ForeSee Results on behalf of Palmetto GBA JM. Please take a minute or two to give us your opinions. The feedback you provide will help Palmetto GBA JM enhance its site and serve you better in the future. All results are strictly confidential.
				Thank You Text - Alternate
				Thank you for taking our survey - and for helping us serve you better. Please note you will not receive a response from us based on your survey comments. If you would like us to contact you about your feedback, please visit the Contact Us section of our web site.

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Sheet 3: Model Qsts

Model Name		CMS - Palmetto GBA JJ MAC v2					Red & Strike-Through: Delete
Model ID							Underlined & Italicized: Re-order
Partitioned		2MQ					Pink: Addition
Date		1/8/2018					Blue: Reword
	Label	Element Questions		Label	Satisfaction Questions		Label	Future Behaviors
		Look and Feel (1=Poor, 10=Excellent, Don't Know)			Satisfaction			Primary Resource (1=Very Unlikely, 10=Very Likely)
1	Look and Feel - Appeal	Please rate the visual appeal of this site.	21	Satisfaction - Overall	What is your overall satisfaction with this site? (1=Very Dissatisfied, 10=Very Satisfied)	24	Primary Resource	How likely are you to use this site as your primary resource for getting information on Medicare?
2	Look and Feel - Balance	Please rate the balance of graphics and text on this site.	22	Satisfaction - Expectations	How well does this site meet your expectations? (1=Falls Short, 10=Exceeds)			Recommend Site (1=Very Unlikely, 10=Very Likely)
3	Look and Feel - Legibility	Please rate the legibility of the pages on this site.	23	Satisfaction - Ideal	How does this site compare to your idea of an ideal site? (1=Not Very Close, 10=Very Close)	25	Recommend Site	How likely are you to recommend this site to someone else?
		Site Performance (1=Poor, 10=Excellent, Don't Know)						Likelihood to Return (1=Very Unlikely, 10=Very Likely)
4	Site Performance - Loading	Please rate how quickly pages load on this site.				26	Return	How likely are you to return to this site?
5	Site Performance - Consistency	Please rate the consistency of speed from page to page on this site.
6	Site Performance - Completeness	Please rate how completely the page content loads on this site.
		Navigation (1=Poor, 10=Excellent, Don't Know)
7	Navigation - Organized	Please rate how well this site is organized.
8	Navigation - Options	Please rate the options available for navigating this site.
9	Navigation - Layout	Please rate how well the site layout helps you find what you need.
		Information Browsing (1=Poor, 10=Excellent, Don't Know)
10	Information Browsing - Sort	Please rate the ability to sort information by criteria that are important to you on this site.
11	Information Browsing - Narrow	Please rate the ability to narrow choices to find the information you are looking for on this site.
12	Information Browsing - Features	Please rate how well the features on the site help you find the information you need.
		Site Information (1=Poor, 10=Excellent, Don't Know)
14	Site Information - Thoroughness	Please rate the thoroughness of information provided on this site.
15	Site Information - Relevant	Please rate how relevant this site’s information is.
16	Site Information - Answers	Please rate how well the site’s information provides answers to your questions.

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Sheet 4: Current CQs

Model Name	CMS - Palmetto GBA JJ MAC v2				Red & Strike-Through: Delete
					Underlined & Italicized: Re-order
Partitioned	2MQ				Pink: Addition
Date	1/8/2018				Blue: Reword
QID	QUESTION META TAG	Skip From	Question Text	Answer Choices	Skip To	Required Y/N	Type	Special Instructions	CQ Label
	Role: Healthcare		Which best describes you?	Provider of medical services		Y	Radio button, one-up vertical	Skip Logic Group*	Best Describes You
				Supplier of medical equipment or supplies
				Staff of a 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	A
		A	Please explain briefly your role in visiting this site.			N	Text area, no char limit	Skip Logic Group*	OE_Best Describes You
	Primary Reason: Healthcare		What is your primary reason for visiting this site today?	Download forms		Y	Radio button, one-up vertical	Skip Logic Group*	Visit Reason
				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
				Access claim status and/or beneficiary eligibility
				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	B
		B	Please explain briefly your primary reason for visiting this site.			N	Text area, no char limit	Skip Logic Group*	OE_Visit Reason
	Accomplish		Did you find what you were looking for?	Yes		Y	Radio button, one-up vertical	Skip Logic Group*	Looking For
				No	C
		C	No, I was looking for:			Y	Text area, no char limit	Skip Logic Group*	OE_Didn't Find
			Did you use the site-wide search feature on this site?	Yes		Y	Radio button, one-up vertical		Use Search
				No
			In the last 30 days, how many times have you visited this website?	This is my first time		Y	Radio button, one-up vertical		Visit Frequency
				Once or twice
				Three or four times
				More than once per week but not every day
				Every day
			Please select your contract. (Select all that apply)	Part A		Y	Checkbox, oneup vertical		Location
				Part B
				Home Health and Hospice
				Not applicable				Mutually Exclusive
			If you would like to be contacted by Palmetto GBA regarding your feedback, please provide your email address and/or phone number.			N	Text area, no char limit		OE_Contact Me
			If you could change anything about our site, what would it be?			N	Text area, no char limit		OE_Change One Thing

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Sheet 5: Types

Types	Instructions	Custom Text
Checkbox, one-up vertical	Anchor Answer Choice	Yes
Checkbox, two-up vertical	EPP	No
Checkbox, three-up vertical	Multiple Lists Group*	Unsure
Drop down, select one	Mutually Exclusive
Radio button, one-up vertical	OPS Group*
Radio button, two-up vertical	Randomize
Radio button, three-up vertical	Rank Group*
Radio button, scale, has don't know	Skip Logic Group*
Radio button, scale, no don't know	True Conversion
Text area, no char limit
Text field, <100 char