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As part of our “You Matter to Molina” program, Molina is committed to partnering with our network providers to work together to solve problems quickly and efficiently. Molina would like your feedback on your recent experiences with your Provider Relations Representative. Please complete the following survey.

Sincerely,
Sara Cooper
VP, Network Management and Operations
Molina Healthcare of (State)

Please assess the level of service you received from your Provider Relations Representative during your last encounter.



As a thank you for taking a few minutes out of your busy day, all completed evaluations will be entered into a monthly drawing to win a gift card!


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* 1. Who is your assigned Provider Relations Representative?

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* 2. My Representative acknowledged my inquiry within 24-48 hours and followed up with a resolution or response within 30 days.

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* 3. My Representative communicated professionally, clearly, and concisely.

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* 4. My Representative provided me with resources or references to support their response.

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* 5. My Representative offered education regarding Molina's online resources and the Availity Essentials portal.

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* 6. I am satisfied with my Representative's overall level of customer service.

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* 7. Please provide any additional feedback concerning your Provider Relations Representative.

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* 8. How do you prefer to receive Molina News and Updates?

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* 9. Please describe any general issues, questions or educational needs that you have, and Molina will have someone respond to you directly.

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* 10. If you prefer email, please provide an email address for Molina News and Updates.

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* 11. Provider Group or Facility Name

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* 12. Provider TIN

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* 13. Name of person completing survey

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* 14. Email of person completing survey

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* 15. Would you like to be entered into a drawing for a gift card?

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* 16. If Yes, please enter your contact information below.

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