TRICARE Satisfaction Survey of Network Providers

B B

B

TRICARE Network Provider Satisfaction Survey
INSTRUCTIONS TO COMPLETE THE SURVEY INSTRUMENT
This TNPSS survey instrument includes the following seven key areas of interface between you and
your Contractor, 123ABC:
Section A:
Section B:
Section C:
Section D:
Section E:
Section F:
Section G:

Provider Inquiries
Provider Communications
Claims Processing
Appeals
Provider Certification
Medical Review
Provider Audit and Reimbursement

aft

•
•
•
•
•
•
•

Most of the key areas pertain to your interactions with your TNPSS Contractor.
For each main section of the survey instrument, you have a choice:

Dr

• Complete the section yourself, or
• Forward the section to the person at your facility who interacts on a regular basis with your TNPSS
Contractor

Once you have completed the survey instrument, please use the enclosed postage-paid envelope and mail it
directly to:
NRC+Picker
PO Box 82660
Lincoln, NE 68501-9465
OR: Fax the completed survey instrument to NRC+Picker at 800-733-5751
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information
unless it displays a valid OMB control number. The valid OMB control number for this information collection is XXXXXXXX. The time required to complete this information collection is estimated to average 16 - 21 minutes per response,
including the time to review instructions, search existing data resources, gather the data needed, and complete and review
the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: HPA&E, XXXXX XXXXXXX, Attn: PRA Reports Clearance Officer, SSSSS,
SSSSSSSSS.

If you have any questions or concerns, please call the TNPSS Provider
Helpline at 800-638-8510 or send an email to TNPSS@nrcpicker.com.

B

B B

*001AMD14*

*001AMD14*

0060421

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TRICARE NETWORK PROVIDER SATISFACTION SURVEY
INTRODUCTION
TRICARE is listening! TRICARE has selected your facility to participate in a satisfaction survey. We know that your time is
valuable and greatly appreciate your willingness to participate in this very important study to assess your satisfaction with
your Contractor.
Please note that your participation is voluntary. The reports prepared for this study will summarize findings across the
sample and will not associate responses with a specific individual. We will not provide information that identifies you to
anyone outside the study team, except as required by law.
Thank you in advance for taking the time to complete the TRICARE Network Provider Satisfaction Survey. If you have any
questions or concerns, please call the TNPSS Provider Helpline at 800-638-8510 or send an email to TNPSS@nrcpicker.com.

ABOUT YOUR FACILITY AND OVERALL SATISFACTION WITH YOUR CONTRACTOR --

Approximately how long have you been a TRICARE Medical Provider?30577
1
E
Less than 6 months
2
E 6 to 12 months
3
E
1 - 2 years
4
E
2 - 5 years
5
E
5 years or more

2.

Approximately what percentage of your patient workload is comprised of TRICARE beneficiaries?30925
1
E
10% or less
2
E
11% - 25%
3
E 26% - 50%
4
E
51% - 75%
5
E
76% - 100%

3.

Are you taking new TRICARE patients?30926
1
E
Yes
2
E
No

Dr

aft

1.

123ABC, your Contractor, provides a number of services on behalf of TRICARE to TRICARE Providers in your area. As you answer the
following question, please rate your level of satisfaction on a scale of 1 to 6, where 1 is "Not at all Satisfied" and 6 is "Completely
Satisfied."

4.

Thinking about all your interactions with your Contractor in the last twelve months, how satisfied have you been with your
Contractor's performance overall?30578
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

B

B B

2
E

3
E

*001AMD25*

4
E

*001AMD25*

5
E

0060421

6
E

-1
E

*00*
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Section A: Provider Inquiries
123ABC has Provider Inquiry staff to answer questions from providers via telephone, written correspondence, or email. You
might use a toll-free number to call the TRICARE Provider Inquiries staff or use a "Call Center" or "Provider Hotline/Help Line."
Please note that Provider Inquiry activities related to this section of the survey instrument are not related to your "Provider
Rep" or "Ombudsman," if you have one. For the purposes of this survey instrument, your "Contractor's Provider Inquiries
performance" includes the activities and interactions that you have with 123ABC related to asking questions and receiving
answers from their Inquiries staff. It should take you approximately two (2) minutes to complete this section.
Your Ratings of 123ABC's Performance of Provider Inquiries
While answering the following questions, please think about your experiences in the last twelve (12) months involving
Provider Inquiries you make to 123ABC (called "your Contractor" in this survey instrument). Please confine your answers only
to your experiences with 123ABC.
For each of the following items in the Provider Inquiries section, please rate your level of satisfaction on a scale of 1 to 6,
where 1 is "Not at all Satisfied" and 6 is "Completely Satisfied." Please mark the bubble below the relevant number.
In the last twelve months, how satisfied have you been with...
The responses to inquiries directed to the MCSC through the provider representatives, TSC, toll-free number, etc.?30923
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

E

5
E

6
E

3
E

E
2

E
3

2
E

3
E

-1
E

Do not know

4
E

5
E

4

5

6 -- Completely
Satisfied

Do not know

E

E

E

E

4

5

6
E

4
E

5
E

E

-89

Not Applicable

-1
E

6

The consistency of responses that you get from different Provider Inquiries representatives30413
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

9.

2
E

Receiving the correct information30411
1 -- Not At All
Satisfied
2
3
1

8.

4
E

How quickly you can reach a representative to make a Provider Inquiry by telephone30607
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

7.

3
E

aft

6.

2
E

Dr

5.

E

-89

Not Applicable

E

-1

Do not know

6
E

-89

Not Applicable

-1
E

E

-89

The effort your Contractor makes to make the Provider Inquiries process as easy as possible for you
30416

1 -- Not At All
Satisfied
1
E

2
2
E

3

4

5

3
E

4
E

5
E

6 -- Completely
Satisfied
6
E

Do not know

Not Applicable

-1
E

E

-89

10. The modes of communication that are offered by your Contractor to exchange information with them about Inquiries30417
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

6
E

-1
E

E

-89

11. The professionalism and courtesy of your Contractor's representatives throughout Provider Inquiries activities
30418

1 -- Not At All
Satisfied
1
E

2

3

4

5

2
E

3
E

4
E

5
E

6 -- Completely
Satisfied
6
E

Do not know

12. Your Contractor's ability to fully resolve problems without you having to make multiple inquiries30579
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

B

B B

2
E

3
E

4
E

*001AMD36*

5
E

*001AMD36*

6
E

0060421

Not Applicable

-1
E

E

-89

Not Applicable

-1
E

*00*

E

-89

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The next few questions are about methods you use to communicate with your Contractor.
13. In the last twelve months, which methods have you used to communicate with your Contractor? (Mark all that apply.)30580
Telephone call
with a Contractor
representative
1
F

Automated
telephone system
2
F

Web

Email

Mail

Fax

Other (Please
specify):
____________________

3
F

4
F

5
F

6
F

7
F

14. In the last twelve months, which method have you used most often to communicate with your Contractor?30581
Telephone call
with a Contractor
representative
1
E

Automated
telephone system
2
E

Web

Email

Mail

Fax

Other (Please
specify):
____________________

3
E

4
E

5
E

6
E

7
E

15. In the last twelve months, how many inquiries have you and any other persons in your facility made?30582
1-2
3-5
6 - 10
11 - 20
21 - 50
51 - 100
1
E

2
E

3
E

4
E

5
E

16. Do you use the Internet to get any of the following? (Mark all that apply.)30583
TRICARE Program
updates
Contractor updates
Training
2
F

Billing and coverage
regulations

3
F

7
E

Other (Please specify):
____________________

4
F

aft

1
F

101 or more

6
E

5
F

Dr

17. We are interested in any general comments you have about 123ABC's handling of Provider Inquiry activities. Do you have any
comments you would like to share with TRICARE and with your Contractor about this topic?

Section B: Provider Communication (Education and Training)

123ABC offers Providers Education and Training in a variety of ways including Web-based training, newsletters, bulletins,
workshops/seminars, videos, on-site training, demonstrations, reference materials, CDs, contractor website, email/listserv, and
so forth. Your organization might also have a "Provider Rep" or "Ombudsman" who acts as a liaison for education issues or
as an actual trainer. For the purposes of this survey instrument, your "Contractor's Education and Training performance"
includes all of these ways that 123ABC provides training and education to your organization. It should take you approximately
two (2) minutes to complete this section.

18. In the last twelve months, what education and training resources of 123ABC have you used? (Mark all that apply.)30584

Web-based
training
1
F

B

B B

Contractor
website
2
F

In-person
training/Workshops
3
F

*001AMD47*

Teleconference
4
F

*001AMD47*

Hard copy
materials
5
F

0060421

None

Other (Please
specify):
____________________

6
F

7
F

*00*
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B
Your Ratings of 123ABC's Performance of Provider Communication
While answering the following questions, please think about your experiences in the last twelve (12) months involving the
types of training resources provided by 123ABC (called "your Contractor" in this survey instrument). Please confine your
answers only to your experiences with 123ABC.
For each of the following items in the Provider Communication section, please rate your level of satisfaction on a scale of 1 to
6, where 1 is "Not at all Satisfied" and 6 is "Completely Satisfied." Please mark the bubble below the relevant number.
In the last twelve months, how satisfied have you been with...
19. The amount of training and educational resources available from your Contractor30608
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

2
E

3
E

20. The detail in which topics are covered30422
1 -- Not At All
Satisfied
2
3
1
E

2
E

3
E

4
E

5
E

4

5

4
E

5
E

21. The tailoring of training or education at a level you can understand30609
1 -- Not At All
Satisfied
2
3
4
5
1
E

2
E

3
E

4
E

E

E

2

3

6 -- Completely
Satisfied

E

E

4

5

1
E

2
E

3
E

4
E

5
E

Dr

2
E

3
E

4
E

25. The expertise of the provider education and training staff30429
1 -- Not At All
Satisfied
2
3
4
1
E

2
E

3
E

4
E

5
E

5
5
E

Do not know

Not Applicable

E

-89

Not Applicable

-1
E

Do not know

E

E

6

E

-89

Not Applicable

E

-1

Do not know

6
E

-89

Not Applicable

-1
E

Do not know

6
E

6 -- Completely
Satisfied

E

-89

-1
E

6 -- Completely
Satisfied

24. The accessibility of education and training resources from your Contractor30428
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

Do not know

6
E

23. The relevance of the training and education material topics to your organization's needs30585
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied

Not Applicable

-1
E

6
E

aft

E
1

6 -- Completely
Satisfied

5
E

22. The topics of the training and education materials are up-to-date30427
1 -- Not At All
Satisfied
2
3
4
5

Do not know

6
E

E

-89

Not Applicable

-1
E

Do not know

6
E

E

-89

Not Applicable

-1
E

E

-89

26. The communication with you about changes that have been or are being made to TRICARE policies and regulations30430
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

6
E

-1
E

27. The professionalism and courtesy of your Contractor's training and education representatives30432
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

2
E

3
E

4
E

5
E

6
E

E

-89

Not Applicable

-1
E

E

-89

28. For which of the following topics would you like to see more training and education material? (Mark all that apply.)30586

Claims
processing
1
F

B

B B

Payment policy
2
F

Local coverage
determination
3
F

*001AMD58*

Enrollment
4
F

*001AMD58*

Appeals
5
F

0060421

Other (Please
Audit and
specify):
reimbursement ____________________
6
F

7
F

*00*
B

B B

B B

B
29. We are interested in any general comments you have about 123ABC's handling of Provider Communication (Education and Training)
activities. Do you have any comments you would like to share with TRICARE and with your Contractor about this topic?

Section C: Claims Processing
123ABC has procedures and regulations associated with how they receive, process, and pay claims that Providers submit.
For the purposes of this survey instrument, your "Contractor's Claims Processing performance" includes the activities and
interactions that you have with 123ABC throughout the lifecycle of a claim submission to payment or denial. It should take you
approximately three (3) minutes to complete this section.

Your Ratings of 123ABC's Performance of Claims Processing
While answering the following questions, please think about your experiences in the last twelve (12) months involving Claims
Processing activities with 123ABC (called "your Contractor" in the survey instrument). Please confine your answers only to
your experiences with 123ABC.

aft

For each of the following items in the Claims Processing section, please rate your level of satisfaction on a scale of 1 to 6,
where 1 is "Not at all Satisfied" and 6 is "Completely Satisfied." Please mark the bubble below the relevant number.
In the last twelve months, how satisfied have you been with...
30. The MCSC claims processing?30922
1 -- Not At All
Satisfied
2
3

E
1

E
2

E
3

E
1

E
2

5

6 -- Completely
Satisfied

Do not know

E

E

E

E

4

5

6 -- Completely
Satisfied

Do not know

E

E

E

E

5

6 -- Completely
Satisfied

Do not know

E

E

E

4

E
3

4

32. The accuracy of your Contractor's claims editing30436
1 -- Not At All
Satisfied
2
3
4

E
1

E
2

5

Dr

31. Obtaining authorizations from the MCSC?30921
1 -- Not At All
Satisfied
2
3

4

E
3

E
4

5

5

6

6

6

Not Applicable

E

-1

-89

Not Applicable

E

-1

-89

Not Applicable

E

-1

-89

33. The timeliness of notification from your Contractor that a claim will not be paid, including denied, returned or unprocessed
claims30437
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

34. The accuracy of remittance advices received from your Contractor30610
1 -- Not At All
Satisfied
2
3
4
5
1
E

2
E

3
E

35. The ease of submitting electronic claims30439
1 -- Not At All
Satisfied
2
3
1
E

B

B B

2
E

3
E

4
E

5
E

4

5

4
E

5
E

*001AMD69*

*001AMD69*

6
E

6 -- Completely
Satisfied
6
E

6 -- Completely
Satisfied
6
E

0060421

-1
E

Do not know

E

-89

Not Applicable

-1
E

Do not know

E

-89

Not Applicable

-1
E

*00*

E

-89

B

B B

B B

B
36. The availability of representatives to address claims-related issues30440
1 -- Not At All
Satisfied
2
3
4
5

E
1

E
2

E
3

E

2
E

3
E

Do not know

E

E

6 -- Completely
Satisfied

Do not know

E

4

5

37. The clarity of remittance advices you receive from your Contractor30587
1 -- Not At All
Satisfied
2
3
4
5
1
E

6 -- Completely
Satisfied

4
E

6

5
E

6
E

2
E

3
E

4
E

5
E

6
E

E

-89

Not Applicable

-1
E

38. The ease of correcting claims, such as correcting claims online or asking for a change over the phone30588
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

Not Applicable

-1

E

-89

Not Applicable

-1
E

E

-89

39. In the past twelve months, how have you submitted claims?30602
1
E
Paper
2
E
Electronic
3
E
Both

aft

40. We are interested in any general comments you have about 123ABC's handling of Claims Processing activities. Do you have any
comments you would like to share with TRICARE and with your Contractor about this topic?

Section D: Appeals

Dr

123ABC has procedures and regulations associated with how and when it addresses Appeals, makes determinations about
Appeals, and communicates with Providers about Appeals decisions. For the purposes of this survey instrument, your
"Contractor's Appeals performance" includes the activities and interactions that you have with 123ABC throughout the
lifecycle of a first-level Appeal -- from when you first receive a denial of a claim to when 123ABC states its decision to reverse
or uphold its decision about paying the claim. It should take you approximately two (2) minutes to complete this section.

41. In the last twelve months, has your facility had a first-level appeal?30603
1
E
Yes
2
E
No (Go to #48)
Your Ratings of 123ABC's Performance of Appeals
While answering the following questions, please think about your experiences in the last twelve (12) months involving
Appeals activities with 123ABC (called "your Contractor" in the survey instrument). Please confine your answers only to your
experiences with 123ABC.
For each of the following items in the Appeals sections, please rate your level of satisfaction on a scale of 1 to 6, where 1 is
"Not at all Satisfied" and 6 is "Completely Satisfied." Please fill in the bubble below the relevant number.
In the last twelve months, how satisfied have you been with...
42. The consistency of your Contractor's decisions about first-level appeals for claims that have been denied30448
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know

E
1

E
2

E
3

E
4

E
5

E
6

Not Applicable

E
-1

E

-89

43. The mechanisms that your Contractor offers for exchanging information with them about first-level appeals30450
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

B

B B

2
E

3
E

4
E

*001AMD7A*

5
E

*001AMD7A*

6
E

0060421

-1
E

*00*

E

-89

B

B B

B B

B
44. Your Contractor's responsiveness, attentiveness, and availability during the process of first-level appeals30589
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know

E
1

E
2

E
3

E

E

4

E

5

6

E

45. The professionalism and courtesy of your Contractor's representatives during the appeals process30604
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

2
E

3
E

4
E

5
E

6
E

46. The clarity of explanations of appeal decisions made by your Contractor30590
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

2
E

3
E

4
E

5
E

6
E

Not Applicable

E

-1

-89

Not Applicable

-1
E

Do not know

E

-89

Not Applicable

-1
E

E

-89

47. We are interested in any general comments you have about 123ABC's handling of Appeals activities. Do you have any comments you
would like to share with TRICARE and with your Contractor about this topic?

Section E: Provider Certification

Dr

aft

123ABC has procedures and regulations associated with how and when they require and make determinations about
applications for Provider Certification in the TRICARE program. For the purposes of this survey instrument, your "Contractor's
Provider Certification performance" includes the activities and interactions that you have with 123ABC regarding enrolling
your organization or members in your facility as a Provider with the TRICARE program. This includes all of your interaction
with the TRICARE Contractor, including initial certification and updates to certification information -- from the first contact you
made with 123ABC through your assignment of a Provider number. It should take you approximately two (2) minutes to
complete this section.

48. In the last twelve months, have you gone through the TRICARE certification process?30605
1
E
Yes
2
E No (Go to #56)
Your Ratings of 123ABC's Performance of Provider Certification
While answering the following questions, please think about your experiences in the last twelve (12) months involving
Provider Certification activities with 123ABC (called "your Contractor" in the survey instrument). Please confine your answers
only to your experiences with 123ABC.
For each of the following items in the Provider Enrollment section, please rate your level of satisfaction on a scale of 1 to 6,
where 1 is "Not at all Satisfied" and 6 is "Completely Satisfied." Please mark the bubble below the relevant number.
In the last twelve months, how satisfied have you been with...
49. The consistency of your Contractor's responses or decisions30456
1 -- Not At All
Satisfied
2
3
4
5
1
E

2
E

3
E

4
E

5
E

6 -- Completely
Satisfied
6
E

Do not know

Not Applicable

-1
E

E

-89

50. The professionalism and courtesy of your Contractor's representatives during the Provider Certification process30459
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

B

B B

2
E

3
E

4
E

*001AMD8B*

5
E

*001AMD8B*

6
E

0060421

-1
E

*00*

E

-89

B

B B

B B

B
51. Your Contractor's responsiveness, attentiveness, and availability during the process of certification30452
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know

E
1

E
2

E
3

E

E

4

E

5

6

52. Your Contractor's ability to answer questions specific to your situation or specialty30457
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied

E
1

E
2

E
3

E

E

4

E

5

6

Not Applicable

E

E

-1

Do not know

-89

Not Applicable

E

E

-1

-89

53. Once your certification was approved, the quality and thoroughness of the information provided by your Contractor to enable
you to start billing for services30458
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

54. The number of contacts made with you by the MCSC?30924
1 -- Not At All
Satisfied
2
3
4
1
E

2
E

3
E

5

4
E

6
E

6 -- Completely
Satisfied

5
E

6
E

-1
E

Do not know

E

-89

Not Applicable

-1
E

E

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aft

55. We are interested in any general comments you have about 123ABC's handling of Provider Certification activities. Do you have any
comments you would like to share with TRICARE and with your Contractor about this topic?

Section F: Medical Review

Dr

123ABC has procedures and regulations that require them to sometimes perform Medical Review of Providers' records. For
the purposes of this survey instrument, your "Contractor's Medical Review performance" includes the activities and
interactions that you have with 123ABC during Pre-Pay and/or Post-Pay Medical Review. Please note that Medical Review
activities in this section of the survey instrument are not related to fraud investigations, overpayments, or appeals. It should
take you approximately two (2) minutes to complete this section.
56. In the last six months, have you had a Medical Review?30460
1
E
Yes
2
E
No (Go to #66)

Your Ratings of 123ABC's Performance of Medical Review
While answering the following questions, think about your experiences in the last twelve (12) months involving Medical
Review activities with 123ABC (called "your Contractor" in the survey instrument). Please confine your answers only to your
experiences with 123ABC.
For each of the following items in the Medical Review section, please rate your level of satisfaction on a scale of 1 to 6, where
1 is "Not at all Satisfied" and 6 is "Completely Satisfied." Please mark the bubble below the relevant number.
In the last twelve months, how satisfied have you been with...

57. The clarity of the notification (letter, phone call, etc.) received that your claims were selected for Medical Review30461
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

B

B B

2
E

3
E

4
E

*001AMD9C*

5
E

*001AMD9C*

6
E

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E

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E

-89

B

B B

B B

B
58. The clarity of the explanations of your Contractor's Medical Review decisions30465
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied

E
1

E
2

E
3

E

E

4

E

5

6

Do not know

E

59. Receiving timely local Medical Review policy changes and updates that affect your organization30466
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

2
E

3
E

4
E

5
E

6
E

60. The follow through that your Contractor provided after Medical Review decisions30468
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

2
E

3
E

4
E

5
E

61. The knowledge of your Contractor's Medical Reviewers30469
1 -- Not At All
Satisfied
2
3
4

E
1

E
2

E
3

E
4

6
E

Do not know

Do not know

E

E
2

E
3

E

E

E

E

E

4

5

E
6

3
E

aft

2
E

4
E

5
E

6
E

Not Applicable

E

-89

Not Applicable

E

-89

Not Applicable

E

E

-1

63. The consistency of your Contractor's Medical Review decisions and answers to your questions30471
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

E

-89

-1

62. How well your Contractor makes an effort to make things as easy and as fair as possible for you30470
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1

Not Applicable

-1
E

6 -- Completely
Satisfied
6

E

-89

-1
E

5
5

Not Applicable

-1

-89

Not Applicable

-1
E

E

-89

64. The professionalism and courtesy of your Contractor representatives throughout the Medical Review process30472
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
2
E

3
E

4
E

5
E

6
E

-1
E

E

-89

Dr

1
E

65. We are interested in any general comments you have about 123ABC's handling of Medical Review activities. Do you have any
comments you would like to share with TRICARE and with your Contractor about this topic?

Section G: Provider Audit and Reimbursement
123ABC has procedures and regulations that require them to work with providers who are paid on either a cost
reimbursement or prospective payment basis for treating TRICARE patients. For the purposes of this survey instrument, your
"Contractor's provider Audit and Reimbursement activities" includes all interactions with 123ABC related to how they decide
and make adjustments to what TRICARE has paid or is supposed to pay your organization, cost report audit activities you may
participate in each year, and interim payments you receive. Please note that Audit and Provider Reimbursement activities in
this section of the survey instrument are not related to the direct payment or denial of claims or to appeals activities related to
claims.
66. In the last twelve months, have you submitted a cost report to 123ABC?30473
1
E
Yes
2
E
No

B

B B

*001AMDAD*

*001AMDAD*

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B

B B

B B

B
If you answered "No" to the question above, please refer to the last page of this survey instrument for instructions for
submitting your completed survey. If you have any questions or concerns, please call the TNPSS Provider Helpline at 800-6388510 or send an email to TNPSS@nrcpicker.com.
Your Ratings of 123ABC's Performance of Provider Audit and Reimbursement
While answering the following questions, think about your experiences in the last twelve (12) months involving Audit and
Reimbursement activities with 123ABC (called "your Contractor" in the survey instrument). Please confine your answers only
to your experiences with 123ABC.
For each of the following items in the provider Audit and Reimbursement section, please rate your level of satisfaction on a
scale of 1 to 6, where 1 is "Not at all Satisfied" and 6 is "Completely Satisfied." Please mark the bubble below the relevant
number.
In the past twelve months, how satisfied have you been with...
67. Availability of timely updates on TRICARE policy (regulations, manuals and other instructions) that affect Provider Audit and
Reimbursement30474
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

6
E

-1
E

E

-89

68. The professionalism and courtesy of your Contractor representatives throughout all Provider Audit and Reimbursement
activities30477
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
2
E

3
E

4
E

5
E

6
E

aft

1
E

-1
E

E

-89

69. How well your Contractor makes an effort to make things as easy and as fair as possible for you during Cost Report settlement
activities30478
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

6
E

E
1

E
2

Dr

70. Your Contractor's interpretations of TRICARE rules for Cost Report and payment policies30591
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied

E
3

E
4

71. The knowledge of your Contractor's Cost Report Auditors30479
1 -- Not At All
Satisfied
2
3
4
1
E

2
E

3
E

4
E

-1
E

Do not know

E

E

E

5

6 -- Completely
Satisfied

Do not know

5

6

5
E

6
E

2
E

3
E

4
E

5
E

6
E

Not Applicable

E

-1

-89

Not Applicable

-1
E

72. The timeliness of your Contractor's audit of your Cost Report, if one is conducted, and the final settlement30482
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

E

-89

E

-89

Not Applicable

-1
E

E

-89

73. The overall communication between you and your Contractor about adjustments and Cost Reports/Cost Report Audits30606
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

6
E

-1
E

E

-89

The next few questions are about Interim Payments you receive from your Contractor
74. The clarity of the instructions given to you by your Contractor for the process of requesting a review and adjustment to your
Interim Payments30484
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

B

B B

2
E

3
E

4
E

*001AMDBE*

5
E

*001AMDBE*

6
E

0060421

-1
E

*00*

E

-89

B

B B

B B

B
75. The reasonableness of the requests the Contractor makes of you during their consideration of an adjustment to your Interim
Payments, including the time you are given to submit documentation and the methods you are given for submitting those
documents30485
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know Not Applicable
1
E

2
E

3
E

4
E

5
E

6
E

-1
E

76. The clarity of the explanations of your Contractor's decisions about adjustments to your Interim Payments30486
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
Do not know
1
E

2
E

3
E

4
E

5
E

6
E

2
E

3
E

4
E

5
E

Not Applicable

-1
E

77. The timeliness of your Contractor's decisions about adjustments to your Interim Payments30487
1 -- Not At All
6 -- Completely
Satisfied
2
3
4
5
Satisfied
1
E

E

-89

6
E

Do not know

E

-89

Not Applicable

-1
E

E

-89

Dr

aft

78. We are interested in any general comments you have about 123ABC's handling of Provider Audit and Reimbursement activities. Do you
have any comments you would like to share with TRICARE and with your Contractor about this topic?

79. Based on your answers to the previous questions, how likely are you to continue your participation with TRICARE?30927
Very likely
Somewhat likely
Somewhat unlikely
Very unlikely
Do Not Know
Not Applicable
1
E

2
E

3
E

4
E

-1
E

E

-89

INSTRUCTIONS FOR SUBMITTING YOUR COMPLETED SURVEY INSTRUMENT
A pre-paid envelope is provided with this survey instrument. Please use it to mail your completed survey directly to:
NRC+Picker
PO Box 82660
Lincoln, NE 68501-9465
OR: Fax your completed survey to NRC+Picker at 800-733-5751
THANK YOU!

B

B B

*001AMDCF*

*001AMDCF*

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B

B B