Please complete the survey below to help us improve the quality of our New Provider Orientation and attest to your attendance. The Ohio Department of Medicaid requires us to maintain a registry of provider attestations for the New Provider Orientation that you attended. Thank you.

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* 1. What is your first and last name?

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* 2. What is your provider, group or facility name?

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* 3. What is your Tax ID number (TIN)?

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* 4. Please enter your email address.

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* 5. Please select the Zoom session you attended in 2024.

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* 6. Please select the Zoom session you attended in 2023.

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* 7. Rate the level of technical information provided.

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* 8. How satisfied are you with the orientation session you attended?

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* 9. Please rate how useful the provided resources are to you or your organization.

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* 10. Was the Q&A session valuable?

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* 11. Rate how well the member eligibility verification procedures were explained.

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* 12. Rate how well the prior authorization procedures were explained.

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* 13. Please share any comments or suggestions about the content, format or logistics that can help AmeriHealth Caritas Ohio improve our New Provider Orientation.

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* 14. By entering your name below, you attest that you have completed AmeriHealth Caritas Ohio's Provider Orientation.

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* 15. Would you like to receive AmeriHealth Caritas Ohio's monthly electronic newsletter, Provider Partnerships?

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