1. Please provide an email address for verification purposes. Responses that do not include a valid email address will not be counted. We will not use your address for any other purpose, nor will we pass it along to any third party.  Total Respondents   0 (skipped this question)   0

2. The company I represent is a vendor of (check all that apply)   Response Percent Response Total   Practice Management systems (PMS)   0% 0   DME systems   0% 0   Laboratory systems   0% 0   Hospital Information Financial or Billing systems (not the same as a PMS)   0% 0   Hospital Information Clinical systems   0% 0   Claims Adjudication systems   0% 0   Document Management systems   0% 0   EDI Translator or Integration software   0% 0   Validation/editing/scrubbing middleware   0% 0   Health Care Clearinghouse services   0% 0   General Purpose EDI VAN services   0% 0   Bank/Financial services   0% 0   Other software or services (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

3. Our customers are (check all that apply)   Response Percent Response Total   Institutional Health Care Providers   0% 0   Professional Health Care Providers   0% 0   Health plans   0% 0   Other (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

4. Please indicate the relative size of the customers you serve (check all that apply)   Response Percent Response Total   Many of our customers are among the largest in their industry   0% 0   Many of our customers are among the smallest in their industry   0% 0   Many of our customers are about average size   0% 0 Total Respondents   0 (skipped this question)   0

5. For practice management and hospital information system vendors: In general, how well does your existing installed customer base integrate their financial and clinical data? (Check all that apply) Almost always Frequently Sometimes Rarely Never Not sure / N/A Response Average Their financial system is closely linked with their clinical system 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 0.00 Their financial system is not well integrated with their clinical system 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 0.00 Their financial system is not integrated whatsoever with their clinical system 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 0% (0) 0.00 Total Respondents   0 (skipped this question)   0

6. Please check all X12N transactions which you currently conduct electronically (either receive, transmit and/or process):   Response Percent Response Total   837 Health Care Claim: Professional   0% 0   837 Health Care Claim: Institutional   0% 0   837 Health Care Claim: Dental   0% 0   835 Health Care Payment Advice   0% 0   270/271 Health Care Eligibility/Benefit Inquiry and Response   0% 0   276/277 Health Care Claims Status Inquiry and Response   0% 0   277 Health Care Claim Status: Unsolicited (or Claim Acknowledgment)   0% 0   278 Health Care Services Review: Request for Review and Response   0% 0   834 Benefit Enrollment and Maintenance   0% 0   820 Payroll Deducted and Other Group Premium Payment for Insurance Products   0% 0   Not sure   0% 0   Other (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

7. Does your company plan to support the business function defined in the X12N 277 Request for Additional Information Implementation Guide (version 4050)?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not sure 0% 0 Total Respondents   0 (skipped this question)   0

8. Does your company plan to support the business function defined in the X12N 275 Additional Information to Support a Health Care Claim Implementation Guide (version 4050)?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not Sure 0% 0 Total Respondents   0 (skipped this question)   0

9. Does your company plan to rely on other vendors to provide software or services for these transactions?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not sure 0% 0 Total Respondents   0 (skipped this question)   0

10. Does your company plan to support unsolicited claim attachments sent with the original claim as part of the same X12 interchange?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not sure 0% 0 Total Respondents   0 (skipped this question)   0

11. Does your company plan to be an early adopter of the X12N 277/275 Information Request and Additional Information transactions?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not Sure 0% 0 Total Respondents   0 (skipped this question)   0

12. Does your company currently provide any type of document management / image services?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not sure 0% 0 Total Respondents   0 (skipped this question)   0

13. If your company currently provides document management services, check the method(s) used:   Response Percent Response Total   Document imaging (scanning)   0% 0   Native document storage (i.e. in Word, pdf, text or similar format)   0% 0   Information is stored in an electronic medical record (CPR, EMR, EHR, etc.)   0% 0   Does not apply   0% 0   Other (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

14. Indicate the functionality that your document management product or service provides to end users (check all that apply):   Response Percent Response Total   Transmit a provider’s document images to a health plan for claims processing/review   0% 0   Transmit a provider’s document images to a health plan for medical review, appeal or other reasons (specify below)   0% 0   Transmit a provider’s document images to another provider for medical management   0% 0   Capture and retain documents/images accessible only to the customer’s organization   0% 0   Extract documents from a system into a non-image file (ie PDF, TXT, Word) for the provider to submit to a trading paartner.   0% 0   Share a document data base accessed by multiple provider organizations   0% 0   Share a document data base accessed by both providers and health plans   0% 0   Does not apply   0% 0   Other/additional info (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

15. Does your company plan to implement or expand support for electronic document management and/or electronic transmission of documents in the next five years?   Response Percent Response Total     Yes 0% 0     No 0% 0     Not Sure 0% 0 Total Respondents   0 (skipped this question)   0

16. If your answer to the previous question is yes, will the system: (check all that apply)   Response Percent Response Total   Transmit a provider’s document images to a health plan for claims processing/review   0% 0   Transmit a provider’s document images to a health plan for medical review, appeal or other reasons (specify below)   0% 0   Transmit a provider’s document images to another provider for medical management   0% 0   Capture and retain documents/images accessible only to the customer’s organization   0% 0   Extract documents from a system into a non-image file (ie PDF, TXT, Word) for the provider to submit to a trading paartner.   0% 0   Share a document data base accessed by multiple provider organizations   0% 0   Share a document data base accessed by both providers and health plans   0% 0   Does not apply   0% 0   Other/additional info (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

17. If you plan to build a solution for electronic claims attachments, are there specific attachment types which will be supported? (check all that apply):   Response Percent Response Total   Laboratory Results   0% 0   Medications (not prescriptions)   0% 0   Clinical Reports (for example: anesthesia, arthroscopy, cardiac catheterization, colonoscopy, consultation note, consultation request, cytology, diagnostic imaging, discharge note, echo heart, EEG brain, EKG, electromyelogram, endoscopy, exercise stress test, flexible sigmoidoscopy, history and physical notes, initial assessment, nursing, operative note, procedure note, progress note, radiology, spirometry, surgical pathology, temperature chart total, visit note)   0% 0   Alcohol-Substance Abuse Rehabilitation   0% 0   Cardiac Rehabilitation   0% 0   Medical Social Services Rehabilitation   0% 0   Occupational Therapy Rehabilitation   0% 0   Physical Therapy Rehabilitation   0% 0   Speech Therapy Rehabilitation   0% 0   Respiratory Therapy Rehabilitation   0% 0   Psychiatric Rehabilitation   0% 0   Skilled Nursing Rehabilitation   0% 0   Emergency Department   0% 0   Ambulance Service   0% 0   Durable Medical Equipment (DME)   0% 0   Home Health Services (skilled nursing in the home)   0% 0   Periodontal Services   0% 0   Children’s Preventive Health Services   0% 0   Consent for Treatment   0% 0   Administrative/non clinical documents (for example, authorization forms, ID cards, itemized bills etc)   0% 0   Other (please specify)   0% 0 Total Respondents   0 (skipped this question)   0

18. What level of investment is your company planning to make for this solution?   Response Percent Response Total     Less than $1 million 0% 0     $1-5 million 0% 0     More than $5 million 0% 0     Not sure/no estimate at this time 0% 0 Total Respondents   0 (skipped this question)   0

19. What factors will drive your decision to provide a solution? (One answer per row) High Moderate Low N/A Response Total Customer demand 0% (0) 0% (0) 0% (0) 0% (0) 0 Competition 0% (0) 0% (0) 0% (0) 0% (0) 0 Trading Partner, business associate or other contract requirements 0% (0) 0% (0) 0% (0) 0% (0) 0 Customer regulatory mandates 0% (0) 0% (0) 0% (0) 0% (0) 0 Upgrade/technological constraints of installed versions of software 0% (0) 0% (0) 0% (0) 0% (0) 0 Readiness of our technology business partners 0% (0) 0% (0) 0% (0) 0% (0) 0 Total Respondents   0 (skipped this question)   0

20. What is your time frame for market introduction and deployment?   Response Percent Response Total     Less than one year 0% 0     One to two years 0% 0     Two to five years 0% 0     Not sure 0% 0 Total Respondents   0 (skipped this question)   0