1.	Our coverage of treatment or clinical services according to nationally recognized standards of care? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
2.	Access to consultations and specialty care with in-network providers? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
3.	Our utilization of review procedures? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
4.	Our credentialing procedures? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
5.	Complaint process at the plan level? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
6.	The amount of paperwork required? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
7.	The amount of telephone contact required? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
8.	The timeliness of claims/capitation payments? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
9.	The accuracy of claims/capitation payments? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
10.	The timeliness of authorizations and precertifications? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
11.	The ease of authorizations and precertifications? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
12.	Our customer service? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
13.	The training we have provided? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
14.	Your participation in our quality management activities? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
15.	How would you rate the overall satisfaction with CHC? Very Satisfied Satisfied Unsatisfied Very Unsatisfied
16.	Have you used the Quick Reference Guide from CHC? Yes No Do Not Know
17.	If you have used the Quick Reference Guide, did you find it helpful? Yes No Do Not Know
18.	Are you familiar with the Healthy Choices, Healthy Families program from CHC? Yes No Do Not Know
19.	Are you familiar with the CHC Kids Clubhouse program? Yes No Do Not Know
20a.	Do you feel CHC increases, decreases or does not affect access to care for patients? Increases Decreases Does Not Affect
20b.	Do you feel CHC increases, decreases or does not affect continuity of care for patients? Increases Decreases Does Not Affect
20c.	Do you feel CHC increases, decreases or does not affect quality of care for patients? Increases Decreases Does Not Affect
20d	Do you feel CHC increases, decreases or does not affect your administrative costs? Increases Decreases Does Not Affect
21.	Would you recommend participation in CHC to a colleague? Yes No NA Do Not Know
22.	Do you file claims electronically? Yes No Plan To Soon
	If you do file claims electronically, what clearinghouse do you use? WebMD/Envoy SSI THIN Other
23.	Have you visited CHC Online (www.communityhealthchoice.org)? Yes No I would like website usage training

	How else can we improve?