Tricare Provider Survey

OMB No. 0704-0553
Exp. XX-XX-XXXX
TRICARE AWARD FEE PROVIDER SATISFACTION SURVEY
A.
Greeting:
Hello, my name is _________ calling from Deloitte/Zogby International, an international
research company conducting a survey on behalf of the Department of Defense TRICARE
Program. May I please speak with (Provider’s name or office manager or billing
supervisor on List)?
YES On line  Go to B.
Not available  “Do you know when (Name) will be available?” If no time is
given or they don’t know, then “Thank you for your time. I will call back later.”
If a time is given, then “Thank you for your time.
I will call back then.”

No such person Thank you and terminate the interview

Refused  Thank you and terminate the interview
For Interviewer Only
Interviewer code -- Reason the sample member is not available

Deceased

Temporarily unavailable

Relocated, new location unknown

Refused call
If person asks what the phone call is about, answer:
We have been contracted to conduct a short survey to get your opinions about dealing
with TRICARE claims and reimbursement. Let me assure you that I am not trying to sell
anything. May I please speak with (name on list)?
B.
When qualified respondent is on the phone:
Hello, I’m _________ calling from Deloitte/Zogby International. We are a research
company conducting a survey for the Department of Defense TRICARE Program. Let me
assure you that I am not trying to sell anything. The Department of Defense is asking
your opinion of the TRICARE claims and reimbursement process. Your participation
helps the Department of Defense evaluate the process. This survey takes less than 5
minutes.
Answering the questions is voluntary. You may ask to skip any question you don’t want to answer
and you can stop at any time. We would like to know what you think. Your answers will be
confidential and any identifying information will be used and protected by the research team, and
will not be tied to your answers when the results are released

Do you have five minutes to answer some questions regarding your experience with the
TRICARE claims and reimbursement process?
If YES  proceed to C.
If NO, then ask “Is there a time that would work better?”
If a time is given, then “Thank you for your time, we will call back
then”.
If respondent refuses  then THANK AND TERMINATE

OMB No. 0704-0553
Exp. XX-XX-XXXX
C.

As you may already know, TRICARE is the United States Department of Defense
health care insurance.

1. All things considered, how satisfied were you with the timeliness of claims payment by
XXX (name the specific TRO region)? Would you say you were…
Completely dissatisfied ....................................................
Very dissatisfied ..............................................................
Somewhat dissatisfied ......................................................
Somewhat satisfied ..........................................................
Very satisfied, or ..............................................................
Completely satisfied.........................................................
(Don’t Read) Not applicable ............................................
(Don’t Read) No Response ..............................................

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2. All things considered, how satisfied were you with the customer service support
provided by XXX (name the specific TRO region)? Examples of customer service
support are your ease and ability to reach the contractor and timely and professional
services. Would you say you were…
Completely dissatisfied ....................................................
Very dissatisfied ..............................................................
Somewhat dissatisfied ......................................................
Somewhat satisfied ..........................................................
Very satisfied, or ..............................................................
Completely satisfied.........................................................
(Don’t Read) Not applicable ............................................
(Don’t Read) No Response ..............................................

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3. All things considered, how satisfied were you with the training, guidance, and
informational assistance provided by XXX (name the specific TRO region)? Would you
say you were…
Completely dissatisfied ....................................................
Very dissatisfied ..............................................................
Somewhat dissatisfied ......................................................
Somewhat satisfied ..........................................................
Very satisfied, or ..............................................................
Completely satisfied.........................................................
(Don’t Read) Not applicable ............................................
(Don’t Read) No Response ..............................................

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4. All insurance companies considered, please rate your satisfaction with XXX (name the
specific TRO region) overall support within your practice for TRICARE beneficiaries?
Would you say you were…
Completely dissatisfied ....................................................
Very dissatisfied ..............................................................
Somewhat dissatisfied ......................................................
Somewhat satisfied ..........................................................

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OMB No. 0704-0553
Exp. XX-XX-XXXX
Very satisfied, or ..............................................................
Completely satisfied.........................................................
(Don’t Read) Not applicable ...........................................
(Don’t Read) No Response ..............................................

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D.
That concludes our survey. Thank you very much for your time this
morning/afternoon/evening.
E.

Interviewer:
If respondent has a question, or needs information, please read the following:
“For eligibility or benefits questions, please call your regional health plan toll
free number: [Contractor’s name] North region 1-877-874-2273. South
region 1-800-444-5445. West Region 1-888-874-9378.
For survey related questions: Call survey contractor’s toll free number at
XXXXXXXXXXX

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average 5
minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing the burden, to
the Department of Defense, Washington Headquarters Services, Executive Services
Directorate, Information Management Division, whs.mc-alex.esd.mbx.dd-dodinformation-collections@mail.mil. Respondents should be aware that notwithstanding
any other provision of law, no person shall be subject to any penalty for failing to comply
with a collection of information if it does not display a currently valid OMB control
number.