Access & Availability Annual Provider Survey
Specialty Care Providers
Provider Name
*
Organization NPI
*
Location Address
*
If there are multiple addresses, please indicate below if the answers are for all addresses or just one.
Is this survey for one location or all locations with this NPI?
*
Just one listed above
All contracted locations
Please select your specialty.
*
Cardiology Services
Chiropractic Services
OB/GYN Services
Ophthalmology/Optometry Services
Therapy Services (Occupational Therapy, Speech Language Pathology, Physical Therapy)
Pediatric Services
Are you accepting new patients at this time?
*
Yes
No
Do you require a referral?
*
Yes
No
Do you provide telehealth services? (Video and/or phone)
*
Yes
No
Is a regular, routine care visit available within 30 business days?
*
Yes
No
Is a regular, routine care visit available within 7 - 10 business days?
*
Yes
No
Is a member able to schedule a follow-up appointment within 30-days of their initial appointment?
*
Yes
No
For calls received outside of business hours, are members instructed on how to access emergency care, how to access an on-call provider, and/or are provided instructions for calling back regarding regular, routine care?
*
Yes
No
Once a member checks-in, is the average wait time for a routine care appointment less than 15 minutes?
*
Yes
No
Submit
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