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* 1. Would you like NASW WI to set up structured liaison with major managed care entities?

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* 2. Which statement best describes your primary practice/clinic? Please check only ONE that best describes your practice.

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* 3. Number of clinicians in your primary practice

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* 4. Which statement best describes your secondary practice/clinic? Please check only ONE that best describes your practice, or skip if you don't have a secondary practice.

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* 5. Number of clinicians in your secondary practice. Skip if you don't have a secondary practice.

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* 6. What are the top 5 - third party fee for service companies that your practice deals with most often? This includes HMOs, Medicaid and Medicaid HMOs, Medicare, and insurance companies. Please use dollars collected to measure this and include the company name in the text box as well.

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* 7. What is the average length of non - billable time you and your staff spend filing statements per claim for each of the companies listed in the previous question? Please use hours to measure this and include the company name in the text box as well.

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* 8. What are some common problems you are facing currently in terms of managed care companies? Please check all that apply.

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* 9. What is the average length of non - billable time you spend per claim obtaining PAs for each of the following? This includes completing forms, making phone calls and getting physician documentation. Please use hours to measure this.

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* 10. Does your practice include In - Home Treatment?

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* 11. If yes, are you experiencing difficulties with Medicaid prior authorizations?

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* 12. If you do offer In - Home Treatment, are you experiencing difficulties getting HMOs to cover this type of treatment?

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* 13. If your practice includes In - Home Treatment, would you be interested in participating in a work group to represent your interests?

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* 14. Since January of 2011, have you experienced a significant increase in time/cost for billing?

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* 15. If you have experienced a significant increase in time billing, please estimate the increase. Please use hours to measure this. If you haven't, please skip this question.

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* 16. If you experienced a significant increase in cost for billing, please estimate this increase using dollars. If you haven't, please skip this question.

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* 17. Any further comments you would like NASW WI to consider?

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