IPA PCP SURVEY 323/889-6562

2010-2011 PROVIDER SATISFACTION SURVEY

We need your help to tell us how well we are doing. Please take a few minutes to fill out this survey about your contracted IPA and fax it back to 323/889-6562 . If
you have any questions, please contact the Quality Improvement Dept at (877) 472-4332. You can also download a Provider Satisfaction Survey from Care1st’s website at
http://www.care1st.com/pdf/2010/provider-survey/ipapcp.pdf

IPA/PCP LAST NAME: FIRST NAME: LICENSE#: FAX:

Please check the box that matches how you feel about the following statements

ADMINISTRATIVE SECTION
Provider Relations TRUE FALSE
4 3 2 1 0
1. I have been supplied with:
A) A provider orientation □ □
B) A provider manual □ □
Strongly Strongly
Agree Agree Disagree Disagree N/A
2. I receive my eligibility lists on time □ □ □ □ □
3. My IPA/Medical Group Provider Representative Associate is:

Name:____________________________________
A) Is knowledgeable □ □ □ □ □
B) Is able to answer my questions □ □ □ □ □
C) Responds to my needs in a timely manner □ □ □ □ □
4 or more 2-3 times a Less than 1
times a year year 1 time a year time's year Not at all

4. My IPA/Medical Group Provider Relations Representative visits my office: □ □ □ □ □

Strongly Strongly
Eligibility/Member Services Agree Agree Disagree Disagree N/A
5. My calls are answered by the IPA courteously □ □ □ □ □
6. My calls are answered by the IPA in a timely manner □ □ □ □ □
7. The Care1st Member Services Representatives are able to assist me □ □ □ □ □
Strongly Strongly
Claims Agree Agree Disagree Disagree N/A
8. My claims are processed in a timely manner □ □ □ □ □
9. My claims are processed according to the contract agreement □ □ □ □ □
10. My claims are processed according to Medi-Cal billing guidelines □ □ □ □ □
11. Claims inquiries are answered promptly □ □ □ □ □
12. Claims phone liaisons are able to answer my questions □ □ □ □ □
Strongly Strongly
Capitation Agree Agree Disagree Disagree N/A
13. My capitation payments are processed in a timely manner □ □ □ □ □
14. My capitation payments I receive from Care1st are accurate □ □ □ □ □
MEDICAL SECTION
Strongly Strongly
Utilization Management Agree Agree Disagree Disagree N/A
15. UM representatives are helpful □ □ □ □ □
16. Referrals are processed in a timely manner □ □ □ □ □
17. Denial notifications consistently provide denial reasons □ □ □ □ □
18. The provider appeals process is easy to follow □ □ □ □ □
Strongly Strongly
Health Education Agree Agree Disagree Disagree N/A
4 3 2 1 0
19. The Information I receive from my IPA regarding the following CA Department of Health Care Services
requirements for health education is helpful:
● IHEBA (Staying Healthy Assessment Tool) □ □ □ □ □
● Breastfeeding promotion □ □ □ □ □
● Referrals to WIC □ □ □ □ □
● Prohibition on distributing samples/materials containing infant formula company logos □ □ □ □ □
● Required health education topics □ □ □ □ □
● Health Education materials review (review for reading level, medical accuracy and cultural sensitivity
and linguistic appropriateness) □ □ □ □ □
● Referrals to Health education services □ □ □ □ □

Care1st Health Plan 601 Potrero Grande Dr., Monterey Park, CA 91755 (877) 472-4332
Health Education (cont'd)
Strongly Strongly
Agree Agree Disagree Disagree N/A
4 3 2 1 0
20. The health education materials I receive from my IPA are helpful to my patients in managing his/her
disease □ □ □ □ □
YES NO UNAWARE OF SCHEDULE
21. I use the monthly schedule of hospital based classes I receive from my IPA to locate health education
classes for my patients □ □ □
Culture & Linguistics (C & L) YES NO UNAWARE OF PROCESS
22. I know how to access the following interpretation services for my patients who need language
assistance:

A. Telephone interpreter services □ □ □

B. Face to Face interpreter services □ □ □
C. Hearing Impaired interpreter services □ □ □
D. Telecommunication Device for Deaf (TDD) California Relay Service □ □ □
23. The office has a procedure in place for handling cultural and language related complaints
□ □ □
24. The office has the following procedures for providing interpreter services to patients: YES NO UNAWARE OF PROCESS

A. After hours answering services have staff members who speak languages other than English □ □ □
B. After hours answering services have the ability to connect to an interpreter over the telephone □ □ □
C. On-call physicians/nurse knows how to connect to an interpreter over the telephone
□ □ □
D. If you have an answering machine does it include instructions to let members know how to get an
interpreter after hours □ □ □
Strongly Strongly
Agree Agree Disagree Disagree N/A

25. I am able to receive the following C & L resources from Care1st Health Plan when I need them:

A. "Free Interpreter services available" sign to post in my office □ □ □ □ □

B. Clear instructions on how to access interpretation services □ □ □ □ □
C. Request or Refusal of Interpreter Services Form □ □ □ □ □
D. Information about State & Federal C & L Requirements □ □ □ □ □
E. Information about cultural and linguistic training for me and my staff □ □ □ □ □
F. Referrals to culturally appropriate services conducted by Community Based Organizations. Some
examples are services for domestic violence, homeless shelters, drug and alcohol abuse. □ □ □ □ □

Strongly Strongly
Quality Improvement Agree Agree Disagree Disagree N/A

26. Care1st's Member Grievance process is effective □ □ □ □ □

27. Care1st's Provider Grievance process is effective □ □ □ □ □
28. Care1st keeps me informed of QI activities that affect my office □ □ □ □ □
YES NO Not Sure
29. I have been informed about the Care1st Cares Disease Management programs? □ □ □
30. I have patients that have been enrolled in Care1st Cares Disease Management programs? □ □ □
Strongly Strongly
Agree Agree Disagree Disagree N/A

31. The Care1st Asthma Disease Management program has been helpful □ □ □ □ □
32. The Care1st Chronic Obstructive Pulmonary Disease (COPD) and Congestive Heart Failure (CHF) □ □ □ □ □
Disease Management programs have been helpful
YES NO UNAWARE OF PROCESS

33. I have been visited or contacted by the Quality Outreach Department? □ □ □

34. I received a Quality Outreach Packet, which includes member listings of services due, medical record
reminder sheets and my individual quality profile?
□ □ □
Strongly Strongly
Agree Agree Disagree Disagree N/A

35. The Care1st preventive service reminders and profiles have been helpful □ □ □ □ □
YES NO UNAWARE OF PROCESS

36. I have contacted the Care1st Quality Improvement toll free information and resource line? □ □ □
Strongly Strongly
37. My Quality Outreach Representative: Agree Agree Disagree Disagree N/A

A) Is knowledgeable about quality projects and incentive programs □ □ □ □ □

B) Is able to answer my questions □ □ □ □ □
C) Responds to my needs or concerns in a timely manner □ □ □ □ □

Care1st Health Plan 601 Potrero Grande Dr., Monterey Park, CA 91755 (877) 472-4332
 Strongly Strongly
Facility Site Reviews Agree Agree Disagree Disagree N/A
38. The Facility Site Review process is fair to providers □ □ □ □ □
39. Facility Site Review auditors were courteous □ □ □ □ □
40. I received my Facility Site Review scores promptly after the survey □ □ □ □ □
41. I was offered assistance by my IPA in completing my Corrective Action Plan □ □ □ □ □
42. Who conducted your most recent FSR?

CARE1ST □ LA CARE □ OTHER HEALTH PLAN □

Strongly Strongly
Pharmacy Agree Agree Disagree Disagree N/A

43. The Care1st Formulary meets my patients' needs □ □ □ □ □

44. The Care1st Pharmacy Staff are able to assist me □ □ □ □ □
45. Care1st Pharmacy Network is adequate for my patients' needs □ □ □ □ □
46. Prior Authorization drug requests are processed in a timely manner □ □ □ □ □
47. The Drug Denial process is consistent □ □ □ □ □
48. Do you receive the Care1st Pharmacy Utilization Report from your IPA □ □ □ □ □
Please provide additional comments or suggestions:

Please provide any IPA specific issues if any: IPA Name:

Your Signature: License #: Date:

Thank you for taking the time to help us

We value your feedback!

Care1st Health Plan 601 Potrero Grande Dr., Monterey Park, CA 91755 (877) 472-4332