We will continue to improve the Indiana Health Coverage Web Site and are very interested in your comments, questions and suggestions. Please submit your comments by completing the survey.

Warning: This is not a secure Web site. Please do not include any protected health information (PHI) that relates to or identifies a patient, client or other individual covered by HIPAA privacy regulations. Thank you.

Organization and Provider Info:
Organization Name  
Provider Name  
Medicaid Provider Number  
Your Name  
Email Address  
Type of Organization  

span style ="font-size:small; font-family:Arial"> 1.  For what general purposes do you use the Indiana Medicaid Web site?

Accessing Bulletins and/or Banner Pages
Accessing Frequently Ask Questions (FAQs)
Checking Benefit Information
Downloading Software
Downloading Forms
Obtaining Claim Filing Information
Other; please specify

2.  What would you like to see improved on the Indiana Medicaid Web site?

Content - if so, please list the type of content needed
Improved Navigation
List of e-mail addresses for key contacts
More Features

3.  Please indicate the features your organization would use if they existed on the Indiana Medicaid Web site.  (Interactive means that the request would be processed immediately and a response would be available through the World Wide Web).

Interactive Claim Submission
Interactive Eligibility Inquiry
Interactive Remittance Advices (RAs)
Interactive Adjustments
Interactive Provider Enrollment
Interactive Claim Inquiry
Interactive Prior Authorization Inquiry

4.  Please choose one score for each question to respond as to how strongly your agree or disagree with the following statements about this site:

(5=Agree 4=Agree Somewhat 3=Neutral 2=Somewhat disagree 1=Disagree)

1. I found the site to be informative and helpful.  
2. It was easy to find the information I needed.  
3. I would visit this site again.  
4. I would recommend this site to others.  

span style ="font-size:small; font-family:Arial">5.  Additional comments: