Hospital Experience Survey

1.Do you know how to reach your Molina Provider Services Representative?(Required.)

Yes

No

3.Did our Provider Services Contact Center Representatives provide clear information and fully resolve your issue?

Yes

No

No experience with the contact center

5.Where do you feel like Molina is exceeding your expectations?(Required.)

6.Where do you feel like Molina is not meeting your expectations?(Required.)

8.Where do you receive your Molina updates (choose all that apply)?(Required.)

10.Which hospital department do you work in?(Required.)

Other (please specify)

11.Are you interested in learning more about our Quality Improvement Programs or our Provider Engagement Team (PET)?(Required.)

Yes

No

12.If answering "Yes," please leave your email address below or reach out to the PET Team at MFLProviderNetworkManagement@MolinaHealthcare.com

13.Are you currently participating in a Joint Operations Meeting?(Required.)

Yes

No

14.If answering "No," and you would like to participate in a Joint Operations Meeting, please add your email address below, or reach out to your Provider Services Representative at MFLProviderNetworkManagement@molinahealthcare.com

15.Are you interested in joining a Provider Advisory Council?(Required.)

Yes

No

16.If you answered "Yes" to joining a Provider Advisory Council, please provide your contact information below:

Group Name

Your Name

TIN

Email Address

Fax Number

Phone Number

Comments

Hospital Experience Survey

Molina Healthcare