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TPA Satisfaction Survey
TPA Satisfaction Survey
MedingenuityAdmin
2020-04-27T21:15:00+00:00
*** This form is for
TPA
use only. IMO Med-Select Network
®
Claims Only. ***
The Network Telephonic Case Manager (TCM) kept me informed of medical and return- to-work plans at onset and during the network process.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The injured employees are able to get in to see a network-treating doctor within a reasonable amount of time.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
TCM made me aware of medical concerns and/or changes in the medical condition in a timely manner.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Generally speaking, the injured employees have provided positive network feedback.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
The network doctor/clinic provides the required DWC73 forms in a timely manner.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
If the injured employee was unable to return to work full duty, the network doctor worked with the employer to get the injured worker back to work on transitional duty, if available.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
Referrals to physical therapists, specialists and diagnostic facilities were handled timely.
*
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
General Comments or Suggestions
Name of TPA
*
We do not use this information to identify you. This is only used to correctly identify the employer.
Please contact me for further comments
Yes
No
Name
Phone
Email
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