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* 1. First name

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* 2. Last name

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* 3. Organization

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* 4. Role/Title

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* 5. Email address

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* 6. In priority order, what are the top 3 challenges your organization faces due to Change Healthcare’s services being unavailable?

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* 7. How likely is your organization to resume using Change Healthcare once it reinstates its services?

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* 8. If you decide to resume using Change Healthcare, would you re-instate all previous services used or consider retaining DentalXChange or ImageNet-DFS? (select all that apply)

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* 9. How is your organization handling medical claims during the Change Healthcare outage?

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* 10. How would you like to receive upcoming communications regarding CHC updates?

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* 11. Would you be comfortable with us reaching out to you to ask more specific questions following this survey?

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