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Provider Satisfaction Survey for 504 Networks
Provider Satisfaction Survey for 504 Networks
MedingenuityAdmin
2021-10-14T22:08:59+00:00
*** This form is for PROVIDER use only. IMO Med-Select 504 Network Claims Only. ***
I have been satisfied with the quality of customer service offered by the IMO Med-Select 504 Network team.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I found the IMO Med-Select 504 Network Website helpful and user friendly.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I was satisfied with both the processing of my billing and payments for services rendered.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I was contacted and given an opportunity for a Peer-to-Peer discussion prior to a decision of non- authorization for all utilization reviews.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I was provided appropriate and timely feedback from all Specialists in the IMO Med-Select 504 Network.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Out of Network referrals were promptly addressed & responded to within 7 days if found to be necessary based on availability and/or accessibility.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
I have a clear understanding of the requirements associated with a 504 Workers’ Compensation Health Care Network.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
General Comments or Suggestions
Name of Employer
*
We do not use this information to identify you. This is only used to correctly identify the employer.
Name of 504 Network
*
Please contact me for further comments
Yes
No
Name
Phone
Email
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