Please inform us how well we are doing by taking a few minutes to fill out this Provider Survey, front and back, about Jai Medical Systems Managed Care Organization, Inc (Jai Medical Systems). Once completed, please fax the Provider Survey back to us at 410-433-4615. If you have any questions about the survey, please contact our Provider Relations Department at 1-888-JAI-1999. For your convenience, you may also download or electronically complete this Provider Survey from our website at http://www.jaimedicalsystems.com. By completing this survey in its entirety, you will be entered to win a $100 gift card (answers will not affect your entry). Please return this survey by December 31, 2017.

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* 1. Provider First Name

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* 2. Provider Last Name

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* 3. NPI

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* 4. Phone

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* 5. Organization Name

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* 6. Individual Completing Survey (other than provider)

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* 7. Title

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* 8. Email

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* 9. I have been a participating provider with Jai Medical Systems for:

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* 10. I am a provider (please specify if you select Specialty Care or Other).

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* 11. I am satisfied with Jai Medical Systems.

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* 12. I would recommend other providers join the Jai Medical Systems’ network as a participating provider.

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* 13. The Jai Medical Systems’ provider network is adequate.

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* 14. What type of provider(s), and what location(s) do you feel Jai Medical Systems should add to their provider network, if any?

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* 15. Jai Medical Systems’ Customer Service Department is friendly, knowledgeable, and helpful.

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* 16. Jai Medical Systems’ Customer Service Department is able to assist with verifying member eligibility and PCP change requests.

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* 17. Jai Medical Systems’ Customer Service Department is able to assist with scheduling appointments and transportation.

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* 18. Jai Medical Systems’ Customer Service Department provides excellent customer service overall.

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* 19. Jai Medical Systems’ Provider Relations Department is friendly, knowledgeable, and helpful.

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* 20. In 2017, I was _________________ by Jai Medical Systems.

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* 21. The credentialing or recredentialing process occurred in a timely manner.

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* 22. For providers who were due for recredentialing; I received appropriate notice on the need to recredential from Jai Medical Systems.

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* 23. I receive excellent service from Jai Medical Systems’ Provider Relations Department.

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* 24. I would like to receive a courtesy call and/or site visit from the Provider Relations Department.

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* 25. How do you submit your claims to Jai Medical Systems?

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* 26. My claims are processed in a timely manner.

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* 27. I feel that Jai Medical Systems’ reimbursement rates are competitive.

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* 28. My claims inquiries are answered promptly.

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* 29. I understand the provider claim appellate process and feel my appeals are reviewed appropriately.

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* 30. Jai Medical Systems’ Utilization Management and Case Management Department is friendly, knowledgeable, and helpful.

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* 31. Jai Medical Systems effectively communicates and assists with coordination of medical care, when necessary.

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* 32. I find that the Jai Medical Systems Case Management / Disease Management programs are helpful.

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* 33. I understand the referral and/or the authorization process.

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* 34. Referrals and/or authorizations are processed in a timely manner.

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* 35. Jai Medical Systems keeps me well informed about its Quality Assurance initiatives and programs.

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* 36. I would like to be contacted by the Jai Medical Systems’ Quality Assurance Department regarding the initiatives and programs.

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* 37. The medications included in the Jai Medical Systems formulary adequately meet the needs of my patients and my practice.

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* 38. Please feel free to provide any additional comments.

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