30628 Q_Novitas-JH_Web_Browse_20170221_DOT

E-Government Website Customer Satisfaction Surveys

Q_Novitas-JH_Web_Browse_20170221_DOT.xlsx

Mapping and Questionnaire Documents IA 30628 A4 (CMS)

OMB: 1090-0008

Document [xlsx]
Download: xlsx | pdf

Overview

Welcome & Thank You Text
New Model
Custom Qs
CQs (8-31-17)


Sheet 1: Welcome & Thank You Text

Model Instance Name:



Red & Strike-Through: Delete

CMS - Novitas JH MAC



Pink: Addition

MID: 1MNYhFF1ok8UlENs08EQlA==





Blue: Reword

Date: 5/13/2016













Welcome and Thank You Text



USE ALTERNATE TEXT FOR WELCOME, STANDARD FOR TY














Welcome Text
Welcome Text - Alternate






We'd welcome your feedback! (return) Thank you for visiting the Novitas Solutions, Inc. You have been selected to participate in a brief customer satisfaction survey to let us know how we can improve your experience. The feedback you provide will help Novitas Solutions enhance its Web site and server you better in the future. (return) The survey is designed to measure your entire experience, please look for it at the conclusion of your visit.
**PLEASE SEE BELOW IN EXAMPLE DESKTOP**






































Thank You Text
Thank You Text - Alternate






Thank you for your time in completing this survey. Your input is very valuable and will be taken into consideration.
Thank you for taking our survey - and for helping us serve you better. We appreciate your input!














































Example Desktop (shows text locations)
Example Desktop (shows text locations)









Rate Your Website Experience














You've been selected to participate in a customer satisfaction survey to help us improve your website experience.














The survey will take 2-3 minutes, and will appear at the conclusion of your visit.






















Buttons: No Thanks, Yes, I'll Help!



















































































































































































Sheet 2: New Model

Model Instance Name:







CMS - Novitas JH MAC v2







F8kAAs51UopAYkNpdMB9tA4C






Partitioned? Yes
2MQ











Date:
1/26/2017




#REF!
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=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.





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 3: Custom Qs

Model Instance Name:










CMS - Novitas JH MAC v2










MID:
F8kAAs51UopAYkNpdMB9tA4C









Date: 1/27/2017








CMS - Novitas JH MAC v2 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 CQ Label
HAJ7210Q001
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










Three or four times










More than once per week but not every day










Every day






HAJ7210Q002
Which best describes you?
Provider of medical services
Radio button, one-up vertical Single Y Skip Logic 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 A





HAJ7210Q003 A Please explain briefly:


Text area, no char limit
N Skip Logic Group* Other-Best Describes You
HAJ7210Q004
What is your primary reason for visiting this site today?
Download forms
Radio button, one-up vertical Single Y Skip Logic Group* Reason for visiting




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










Find contact information










Find general Medicare program information










Access claim status and/or beneficiary eligibility










Research a specific question on Medicare policy or billing








d
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





HAJ7210Q005 B Please explain briefly:


Text area, no char limit
N Skip Logic Group* Other-Primary Reason
HAJ7210Q006
What topics or features did you access today? (please check all that apply)
Appeals
Checkbox, one-up vertical Multi Y Skip Logic Group* Features or Topics




Claims/Eligibility










Educational Events










Electronic Billing (EDI)










Enrollment










Fee Schedules










Forms Catalog










Medical Policy










Medicare News & Articles










Novitasphere










Self-Service Tools (Fee Schedule Search, Enrollment Status, Policy Search)










Other C









None of these/Not applicable



Mutually Exclusive

HAJ7210Q007 C What other topics or features did you access?


Text area, no char limit
N Skip Logic Group* Other Feature
HAJ7210Q008
Did you use any search features located on the Novitas site today?
Yes A, B Radio Button, one-up vertical Single Y Skip Logic Group Search Usage



No






HAJ7210Q009 A Which search features did you use?
Regular Entire Site search box (top right corner of pages) using keywords C, D Checkbox, one-up vertical Multi Y Skip Logic Group Type of Search



Medical Policy/LCDs search tool









Fee Schedule Code Search









Enrollment Status Tool









Other






HAJ7210Q010 B Did you try using the site's navigational links before using the search feature today?
Yes, I navigated or browsed the site first
Radio Button, one-up vertical Single Y Skip Logic Group Search First



No, I went straight to the search feature









Don't recall






HAJ7210Q011 C Please tell us which search term(s) you used:


Text field, <100 char
N Skip Logic Group Search_Terms
HAJ7210Q012 D Which best defines your experience with the site's regular search feature today (excluding Medical Policy/LCD search)?
Search results were helpful
Checkbox, one-up vertical Multi Y Mutually Exclusive Search Experience



Results were not relevant/not what I wanted E


Skip Logic Group




Too many results/I needed to refine my search E








Not enough results E








Returned NO results E





HAJ7210Q013 E Please briefly describe your search experience.


Text area, no char limit
N Skip Logic Group Search OE Experience
HAJ7210Q014
Were you able to accomplish your goal by visiting our website today?
Yes
Radio button, one-up vertical Single Y Skip Logic Group* Accomplish Goal




No J





HAJ7210Q015 J Please explain what you were unable to accomplish on the website:


Text area, no char limit
N Skip Logic Group* Reason for Visit
HAJ7210Q016
Do you have any suggestions to help us make our web site better?


Text area, no char limit
N
Improvement
HAJ7210Q017
Did you use Novitasphere (our web-based access portal for claims and eligibility) today?
Yes Q, K, R Radio button, one-up vertical Single Y Skip Logic Group* Portal Usage




No






HAJ7210Q018 Q What is your primary reason for coming to the Novitasphere portal today?
Retrieve benefits and eligibility information
Radio button, one-up vertical Single Y Skip Logic Group* Portal Reason




View Claim Summary information










Retrieve claims status information










Submit claims










Perform a Claim Correction/Reopening










Obtain a duplicate remittance advice










Access my Novitasphere mailbox










Download reports (999, 277CA, 835)










Other






HAJ7210Q019 K How often do you use Novitasphere?
Daily
Radio button, one-up vertical Single Y Skip Logic Group* Portal Visits




Weekly










Monthly or less often






HAJ7210Q020 R Did you accomplish what you wanted to do in Novitasphere?
Yes
Radio button, one-up vertical Single Y Skip Logic Group* Portal Accomplish




No Y





HAJ7210Q021 Y What were you unable to accomplish in Novitasphere?


Text area, no char limit
Y Skip Logic Group* Portal Unable
HAJ7210Q022 If you are over the age of 18 and were unable to accomplish your goal today, may we contact you to offer further assistance?
Yes C Radio button, one-up vertical Single N Skip Logic Group* Contactable




No






HAJ7210Q023 C Please provide us with your full name along with an e-mail address and telephone number where you can be reached:


Text area, no char limit
Y Skip Logic Group* Contact Info

Sheet 4: CQs (8-31-17)

Model Instance Name:










CMS - Novitas JH MAC v2










MID:
F8kAAs51UopAYkNpdMB9tA4C









Date: 1/27/2017








CMS - Novitas JH MAC v2 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 CQ Label
HAJ7210Q001
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










Three or four times










More than once per week but not every day










Every day






HAJ7210Q002
Which best describes you?
Provider of medical services
Radio button, one-up vertical Single Y Skip Logic 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 A





HAJ7210Q003 A Please explain briefly:


Text area, no char limit
N Skip Logic Group* Other-Best Describes You
HAJ7210Q004
What is your primary reason for visiting this site today?
Download forms
Radio button, one-up vertical Single Y Skip Logic Group* Reason for visiting




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










Find contact information










Find general Medicare program information










Access claim status and/or beneficiary eligibility










Research a specific question on Medicare policy or billing








d
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





HAJ7210Q005 B Please explain briefly:


Text area, no char limit
N Skip Logic Group* Other-Primary Reason
HAJ7210Q006
What topics or features did you access today? (please check all that apply)
Appeals
Checkbox, one-up vertical Multi Y Skip Logic Group* Features or Topics




Claims/Eligibility










Educational Events










Electronic Billing (EDI)










Enrollment










Fee Schedules










Forms Catalog










Medical Policy










Medicare News & Articles










Novitasphere










Self-Service Tools (Fee Schedule Search, Enrollment Status, Policy Search)










Other C









None of these/Not applicable



Mutually Exclusive

HAJ7210Q007 C What other topics or features did you access?


Text area, no char limit
N Skip Logic Group* Other Feature
HAJ7210Q008
Did you use any search features located on the Novitas site today?
Yes A, B Radio Button, one-up vertical Single Y Skip Logic Group Search Usage



No






HAJ7210Q009 A Which search features did you use?
Regular Entire Site search box (top right corner of pages) using keywords C, D Checkbox, one-up vertical Multi Y Skip Logic Group Type of Search



Medical Policy/LCDs search tool









Fee Schedule Code Search









Enrollment Status Tool









Other






HAJ7210Q010 B Did you try using the site's navigational links before using the search feature today?
Yes, I navigated or browsed the site first
Radio Button, one-up vertical Single Y Skip Logic Group Search First



No, I went straight to the search feature









Don't recall






HAJ7210Q011 C Please tell us which search term(s) you used:


Text field, <100 char
N Skip Logic Group Search_Terms
HAJ7210Q012 D Which best defines your experience with the site's regular search feature today (excluding Medical Policy/LCD search)?
Search results were helpful
Checkbox, one-up vertical Multi Y Mutually Exclusive Search Experience



Results were not relevant/not what I wanted E


Skip Logic Group




Too many results/I needed to refine my search E








Not enough results E








Returned NO results E





HAJ7210Q013 E Please briefly describe your search experience.


Text area, no char limit
N Skip Logic Group Search OE Experience
HAJ7210Q014
Were you able to accomplish your goal by visiting our website today?
Yes
Radio button, one-up vertical Single Y Skip Logic Group* Accomplish Goal




No J





HAJ7210Q015 J Please explain what you were unable to accomplish on the website:


Text area, no char limit
N Skip Logic Group* Reason for Visit
HAJ7210Q016
Do you have any suggestions to help us make our web site better?


Text area, no char limit
N
Improvement
HAJ7210Q017
Did you use Novitasphere (our web-based access portal for claims and eligibility) today?
Yes Q, K, R Radio button, one-up vertical Single Y Skip Logic Group* Portal Usage




No






HAJ7210Q018 Q What is your primary reason for coming to the Novitasphere portal today?
Retrieve benefits and eligibility information
Radio button, one-up vertical Single Y Skip Logic Group* Portal Reason




View Claim Summary information










Retrieve claims status information










Submit claims










Perform a Claim Correction/Reopening










Obtain a duplicate remittance advice










Access my Novitasphere mailbox










Download reports (999, 277CA, 835)










Other






HAJ7210Q019 K How often do you use Novitasphere?
Daily
Radio button, one-up vertical Single Y Skip Logic Group* Portal Visits




Weekly










Monthly or less often






HAJ7210Q020 R Did you accomplish what you wanted to do in Novitasphere?
Yes
Radio button, one-up vertical Single Y Skip Logic Group* Portal Accomplish




No Y





HAJ7210Q021 Y What were you unable to accomplish in Novitasphere?


Text area, no char limit
Y Skip Logic Group* Portal Unable
HAJ7210Q022 If you are over the age of 18 and were unable to accomplish your goal today, may we contact you to offer further assistance?
Yes C Radio button, one-up vertical Single N Skip Logic Group* Contactable




No






HAJ7210Q023 C Please provide us with your full name along with an e-mail address and telephone number where you can be reached:


Text area, no char limit
Y Skip Logic Group* Contact Info
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