30628 Q_NGSJ6_Web_Browse_20180618_DOT

E-Government Website Customer Satisfaction Surveys

Q_NGSJ6_Web_Browse_20180618_DOT.xlsx

Mapping and Questionnaire Documents IA 30628 A4 (CMS)

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Model Questions
Current CQs
CQs (6-18-18)
CQs (12-4-17)
CQs (11-2-17)
CQs (10-13-17)
CQs (4-21-17)
CQs (3-7-17)


Sheet 1: Model Questions

Model Instance Name:







CMS - NGS JK MAC V2







MID: cJscBVQFAoYYkwtkNAQhcg4C





Partitioned? Yes
2MQ











Date:
2/21/2017




CMS - NGS JK MAC V2
Model questions utilize the ACSI methodology to determine scores and impacts


ELEMENTS (drivers of satisfaction)

CUSTOMER SATISFACTION

FUTURE BEHAVIORS

MQ Label

MQ Label

MQ Label


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

Satisfaction

Primary Resource
(1=Not Very Likely, 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
(1=Not Very Likely, 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 How likely are you to recommend this site to someone else?


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




Likelihood to Return
(1=Not Very Likely, 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.





13
Site Information (1=Poor, 10=Excellent, Don't Know)






Site Information - Thoroughness Please rate the thoroughness of information provided on this site.





14 Site Information - Relevant Please rate how relevant this site’s information is.





15 Site Information - Answers Please rate how well the site’s information provides answers to your questions.





































































































































Sheet 2: Current CQs

Model Instance Name:

red & strike-through: DELETE





CMS - NGS J6 MAC V2

underlined & italicized: RE-ORDER





MID: slVJU59EwUcss810do1EAQ4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS J6 MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
RUS0196078
We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.


N
Email Follow Up
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y
Visit Frequency

Once or twice


Three or four times


More than once per week but not every day


Every day

HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E
RUS0200444 E What specific task were you trying to accomplish today? Create an NGSConnex account
Radio button, one-up vertical Y Skip Logic Group* Specific Task

Submit a claim
Randomize

View/print beneficiary eligibility information



Submit reopening or redetermination



View/print remittances



Respond to an ADR



View claim status and/or claim overlap information



View status of a check/EFT



Something Else EA Anchor Answer Choice
HAJ7213Q008 EA What were you trying to accomplish? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most


Sheet 3: CQs (6-18-18)

Model Instance Name:

red & strike-through: DELETE





CMS - NGS J6 MAC V2

underlined & italicized: RE-ORDER





MID: slVJU59EwUcss810do1EAQ4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS J6 MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
RUS0196078
We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.


N
Email Follow Up
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y
Visit Frequency

Once or twice


Three or four times


More than once per week but not every day


Every day

HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E
RUS0200444 E What specific task were you trying to accomplish today? Create an NGSConnex account
Radio button, one-up vertical Y Skip Logic Group* Specific Task

Submit a claim
Randomize

View/print beneficiary eligibility information



Submit reopening or redetermination



View/print remittances



Respond to an ADR



View claim status and/or claim overlap information



View status of a check/EFT



Something Else EA Anchor Answer Choice
HAJ7213Q008 EA What were you trying to accomplish? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most


Sheet 4: CQs (12-4-17)

Model Instance Name:

red & strike-through: DELETE





CMS - NGS J6 MAC V2

underlined & italicized: RE-ORDER





MID: slVJU59EwUcss810do1EAQ4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS J6 MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y
Visit Frequency

Once or twice


Three or four times


More than once per week but not every day


Every day

HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E

E What specific task were you trying to accomplish today? Create an NGSConnex account
Radio button, one-up vertical Y Skip Logic Group* Specific Task

Submit a claim
Randomize

View/print beneficiary eligibility information



Submit reopening or redetermination



View/print remittances



Respond to an ADR



View claim status and/or claim overlap information



View status of a check/EFT



Something Else EA Anchor Answer Choice
HAJ7213Q008 EA What were you trying to accomplish? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most


We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.


N
Email Follow Up


Sheet 5: CQs (11-2-17)

Model Instance Name:

red & strike-through: DELETE





CMS - NGS JK MAC V2

underlined & italicized: RE-ORDER





MID: cJscBVQFAoYYkwtkNAQhcg4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS JK MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y
Visit Frequency

Once or twice


Three or four times


More than once per week but not every day


Every day

HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E
HAJ7213Q008 E What were you trying to locate? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most
HAJ7213Q022
From time to time, National Government 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 phone number and or email address. 

Text area, no char limit N
Email Address


We’re here to help. If you would like assistance with your website experience, please leave your email address and/or phone number and we will reach out to you as soon as possible.


N
Email Follow Up


Sheet 6: CQs (10-13-17)

Model Instance Name:

red & strike-through: DELETE





CMS - NGS JK MAC V2

underlined & italicized: RE-ORDER





MID: cJscBVQFAoYYkwtkNAQhcg4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS JK MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y
Visit Frequency

Once or twice


Three or four times


More than once per week but not every day


Every day

HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P, X Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


JIB0151806 X During your visit today, did you notice the redesign of the NGS site? Yes Y, Z Radio button, one-up vertical Y Skip Logic Group New Site_Notice Redesign



No





JIB0151808 Y How does the new site compare to the previous design? New site is an improvement
Radio button, one-up vertical Y Skip Logic Group New Site_Compare



New site is comparable








New site is inferior Y1




JIB0151809 Y1 Please tell us why you feel the new site is inferior to the previous site.

Text area, no char limit N Skip Logic Group OE_New Site_Compare
JIB0151807 Z Please tell us whether you agree or disagree with the following statement:
The new site makes it easier to complete my task.
Strongly Disagree
Radio button, one-up vertical Y Skip Logic Group New Site_Task



Disagree








Neutral








Agree








Strongly Agree








Don't know





HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E
HAJ7213Q008 E What were you trying to locate? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most
HAJ7213Q022
From time to time, National Government 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 phone number or email address.

Text area, no char limit N
Email Address


Sheet 7: CQs (4-21-17)

Model Instance Name:

red & strike-through: DELETE





CMS - NGS JK MAC V2

underlined & italicized: RE-ORDER





MID: cJscBVQFAoYYkwtkNAQhcg4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS JK MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y Skip Logic Group Visit Frequency

Once or twice A

Three or four times A

More than once per week but not every day A

Every day A
HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P, X Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


JIB0151806 A X During your visit today, did you notice the redesign of the NGS site? Yes B,C Y, Z Radio button, one-up vertical Y Skip Logic Group New Site_Notice Redesign



No





JIB0151808 B Y How does the new site compare to the previous design? New site is an improvement
Radio button, one-up vertical Y Skip Logic Group New Site_Compare



New site is comparable








New site is inferior B1 Y1




JIB0151809 B1 Y1 Please tell us why you feel the new site is inferior to the previous site.

Text area, no char limit N Skip Logic Group OE_New Site_Compare
JIB0151807 C Z Please tell us whether you agree or disagree with the following statement:
The new site makes it easier to complete my task.
Strongly Disagree
Radio button, one-up vertical Y Skip Logic Group New Site_Task



Disagree








Neutral








Agree








Strongly Agree








Don't know





HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E
HAJ7213Q008 E What were you trying to locate? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most
HAJ7213Q022
From time to time, National Government 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 phone number or email address.

Text area, no char limit N
Email Address


Sheet 8: CQs (3-7-17)

Model Instance Name:

red & strike-through: DELETE





CMS - NGS JK MAC V2

underlined & italicized: RE-ORDER





MID: cJscBVQFAoYYkwtkNAQhcg4C
pink: ADDITION





Date:
blue + -->: REWORDING





CMS - NGS JK MAC V2 CUSTOM QUESTION LIST
QID Skip Logic Label Question Text Answer Choices
(limited to 50 characters)
Skip to Type (select from list) Required
Y/N
Special Instructions CQ Label
HAJ7213Q001
Which best describes you? Provider of medical services
Radio button, one-up vertical Y OPS Group* Best Describes You

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
HAJ7213Q002 A Other - which best describes you?

Text field, <100 char N OPS Group* Other Role
HAJ7213Q003
In the last 30 days, how many times have you visited this website? This is my first time
Radio button, one-up vertical Y Skip Logic Group Visit Frequency

Once or twice A

Three or four times A

More than once per week but not every day A

Every day A

A During your visit today, did you notice the redesign of the NGS site? Yes B,C Radio button, one-up vertical Y Skip Logic Group New Site_Notice Redesign



No






B How does the new site compare to the previous design? New site is an improvement
Radio button, one-up vertical Y Skip Logic Group New Site_Compare



New site is comparable








New site is inferior B1





B1 Please tell us why you feel the new site is inferior to the previous site.

Text area, no char limit N Skip Logic Group OE_New Site_Compare

C Please tell us whether you agree or disagree with the following statement:
The new site makes it easier to complete my task.
Strongly Disagree
Radio button, one-up vertical Y Skip Logic Group New Site_Task



Disagree








Neutral








Agree








Strongly Agree








Don't know





HAJ7213Q004
Which website(s) did you visit today? (Select all that apply) NGSConnex B, AA, AP, AJ, AK, P Check box, one-up vertical Y Skip Logic Group Websites

NGSMedicare as a REGISTERED user B, AA, AB, AC, AH, AI



NGSMedicare as a GUEST user B, AA, AB, AC, AH, AI


HAJ7213Q005 B What is your primary reason for visiting this site today? Access claim status and/or beneficiary eligibility
Radio button, one-up vertical Y Skip Logic Group* Visit Reason

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


Download forms


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


Find contact information


Find general Medicare program information


Take an on-line training course


Other (please specify) BB
HAJ7213Q006 BB Please specify your other reason for visiting this site today.

Text area, no char limit N Skip Logic Group* Other Reason
HAJ7213Q007 AA While visiting the site, did you find what you were looking for? Yes
Dropdown, Select One Y Skip Logic Group Find

No E

Not yet E
HAJ7213Q008 E What were you trying to locate? (Please be specific)

Text area, no char limit N Skip Logic Group OE_Find
HAJ7213Q009 AB How did you navigate the website(s) today? (Select all that apply) Top navigation menu
Checkbox, one-up vertical Y Skip Logic Group Navigate

Left navigation menu


Quick links on the right side of the page


Searched using the site search feature AD

Bookmarks


Other Z
HAJ7213Q010 AD How would you rate the helpfulness of the search results? Not helpful at all
Dropdown, Select One Y Skip Logic Group Search Useful

Somewhat helpful


Very helpful

HAJ7213Q011 Z Please specify how you navigated the website(s) today.

Text area, no char limit N Skip Logic Group OE_Navigate
HAJ7213Q012 AC What features did you use during your visit today? (Select all that apply) Self-Service Tools (calculators, education, forms, IVR, transactions, etc.) AE, AG Checkbox, one-up vertical Y Skip Logic Group Features/tools

Educational Content (Medicare University, policy education, training events, calendar and summaries, New Supplier Center, etc.) AF


None of the above
Mutually Exclusive
HAJ7213Q013 AE How would you rate the helpfulness of the Self-Service tools you used today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Tools

Somewhat helpful


Very helpful

HAJ7213Q014 AG What one thing would you improve or add to the Self-Service tools?

Text area, no char limit N Skip Logic Group OE_improve tools
HAJ7213Q015 AF How would you rate the helpfulness of the educational content on NGSMedicare.com? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Edu Content

Somewhat helpful


Very helpful

HAJ7213Q016 AH What one improvement would you like to see made to NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Improvement
HAJ7213Q017 AI What do you like most about NGSMedicare?

Text area, no char limit N Skip Logic Group OE_Medicare_Like Most
HAJ7213Q018 AP As a National Government Services Connex user, did you try using any of the following tools today in order to accomplish your task? (Select all that apply) Entitlement inquiries
Checkbox, one-up vertical Y Skip Logic Group Tools Used


Same/similar inquiries





Reopenings





Redeterminations






Responding to additional documentation requests (ADRs)






Other







None of the above


Mutually Exclusive

HAJ7213Q019 P How would you rate the helpfulness of the NGSConnex portal in your visit today? Not helpful at all
Dropdown, Select One Y Skip Logic Group Rate Portal


Somewhat helpful





Very helpful



HAJ7213Q020 AJ What one improvement would you like to see made to NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Improvement
HAJ7213Q021 AK What do you like most about NGSConnex?

Text area, no char limit N Skip Logic Group OE_Connex_Like Most
HAJ7213Q022
From time to time, National Government 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 phone number or email address.

Text area, no char limit N
Email Address

File Typeapplication/vnd.openxmlformats-officedocument.spreadsheetml.sheet
File Modified0000-00-00
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