A1. Hello, have I reached [PHARMACY]?
PHONE NUMBER: [PHARMACY TELEPHONE NUMBER]
[IF A1 = 1 GO TO A2,
IF A1 = 2 GO TO CONTACT BLOCK,
IF A1 = 3 GO TO EXIT]
A2. I have [an] authorization form[s] for the release of patient profiles and would like to speak to the pharmacist.
[IF A2= 1 GO TO B1,
IF A2=2, GO TO CONTACT BLOCK
IF A2=3 GO TO EXIT SCREEN]
B1. My name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services.
We are conducting MEPS which is a study about how people in the United States use and pay for health care.
For quality assurance and training purposes, this case may be monitored.
POC: [POC NAME]
READ IF NECESSARY: I have [an] authorization form[s] for the release of patient profiles and would like to speak to the pharmacist.
[IF B1=1, GO TO B2,
IF B1=2, GO TO CONTACT BLOCK;]
B2. At this time, [NUMBER FROM CUSTOMER LIST] of your customers identified [PHARMACY] as a place where they received prescribed medication during 2016. [The/Each] customer signed an authorization form allowing us to contact you for information about the prescribed medication they received from [PHARMACY] in 2016. Much of the information we need is within the patient profiles. Are the patient profiles maintained in your office, in another department or your corporate office?
PHARMACY MAINTAINS THE PROFILES = 1
NEED TO CONTACT CORPORATE/OTHER DEPARTMENT FOR AUTHORIZATION = 2
[IF B2 = 1 GO TO B2b,
IF B2= 2 GO TO B2_1]
B2_1. Are you the person who deals with the (other department/corporate office)?
[IF B2_1 = 1, GO TO C2,
IF B2_1 = 2, GO TO B2a]
B2a. I’ll need to collect the name and telephone number for the person in your office who deals with (your corporate office/the other department).
NEXT BUTTON TAKES USER TO CONTACT BLOCK
B2b. I would like to fax the authorization form[s] to you, along with additional information explaining the study. I need to be sure I have the correct information for the packet. Should I direct it to you?
[GO TO CONTACT BLOCK]
C1. Hello, my name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services.
We are conducting MEPS which is a study about how people in the United States use and pay for health care.
For quality assurance and training purposes, this call may be monitored
POC: [POC NAME]
READ IF NECESSARY: I have [an] authorization form[s] for the release of patient profiles and would like to speak to the person that can help me get in touch with (the department who maintains patient profiles/your corporate office).
[IF C1=1, GO TO C2,
IF C1=2, GO TO CONTACT BLOCK]
C2. (READ IF NECESSARY: At this time, [NUMBER FROM CUSTOMER LIST] customer[s] identified [PHARMACY] as a place that they received prescribed medication during 2016. [The/Each] customer signed an authorization form allowing us to contact you for information about the prescribed medication they received in 2016.)
We should be able to get all of the information we need from (the other department/your corporate office).
We can also fax you a copy of the authorization form[s] for your files
I need to be sure I have the correct information for the packet. Should I direct it to you?
[GO TO CONTACT BLOCK]
D1. Have I reached [OTHER DEPARTMENT/CORPORATE OFFICE]?
PHONE NUMBER: [OTHER DEPARTMENT/CORPORATE OFFICE TELEPHONE NUMBER]
[IF D1 = 1 GO TO D2,
IF D1 = 2 GO TO EXIT]
D2. I have [an] authorization form[s] for the release of patient profiles and would like to speak to the person that can help me with that process.
READ IF NECESSARY: We are interested in collecting profiles for each customer that includes the amount paid by the customer and the amount paid by any third party payers for all prescriptions in 2016. We are also interested in collecting the NDC, date filled or refilled, and quantity dispensed with dosage form. We would appreciate it if you could also include the types of the third parties.
IF THE PERSON YOU NEED TO TALK TO IS UNAVAILABLE ATTEMPT TO GET THEIR CONTACT INFORMATION VIA THE CONTACT BLOCK AND SET AN APPOINTMENT IF POSSIBLE.
[IF D2= 1 GO TO E1,
IF D2=2 OR 3, GO TO EXIT SCREEN]
E1. Hello, my name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services. We are conducting MEPS which is a study about how people in the United States use and pay for health care. For quality assurance and training purposes, this call may be monitored.
POC: [POC NAME]
READ IF NECESSARY: I have [an] authorization form[s] for the release of patient profiles and would like to speak to the person that can help me with that process.
[IF E1=1, GO TO E2,
IF E1=2, GO TO CONTACT BLOCK;]
E2. (READ IF NECESSARY: At this time, [NUMBER FROM CUSTOMER LIST] customer[s] identified [PHARMACY] as a place where they received prescribed medication during 2016. [The/Each] customer signed an authorization form allowing us to contact you for information about the prescribed medication they received in 2016.)
I would like to fax the authorization form[s] to you, along with additional information explaining the study.
I need to be sure I have the correct information for the packet. Should I direct it to you?
[GO TO CONTACT BLOCK]
F1. Once you have received the authorization form[s] [if # of customers is < or =25, show “we will call back to collect the data over the phone”, if # of customers is >25, show “you can send us the patient profiles by either fax or mail, or we can call back to collect the data over the phone.”] We are interested in collecting profiles for each customer that includes the amount paid by the customer and the amount paid by any third party payers for all prescriptions in 2016. We are also interested in collecting the NDC, date filled or refilled, and quantity dispensed with dosage form. We would appreciate it if you could also include the types of the third parties.
[IF F1 = 1 GO TO F2,
IF F1 = 2 GO TO F2,
IF F1 = 3 GO TO F2]
F2. Within the next 24 hours we will [fax/mail] you the authorization form[s] and include an instruction sheet. If you have any questions about what to send us, please call our toll-free number on the instruction sheet. We will call to verify that you received the authorization forms.
[We will work with you to set up a good time to collect the data over the phone. /
We may call again if other customers identify this pharmacy as a source of prescribed medication.]
[Instrument logic will be implemented so text only appears on screen when provider verification has not been completed: Before we send you the form(s) I’ll need to determine that all of the providers I have listed were in fact associated with this pharmacy in 2016. I’m going to read you a list of providers; please tell me if each one was associated with this pharmacy in 2016.]
[GO TO EXIT]
G_Intro. May I please speak to [POC NAME]?
[IF G_Intro=1, GO TO G1,
IF G_Intro =2, GO TO APPOINTMENT SCREEN]
G1. Hello, my name is (YOUR NAME). I am calling on behalf of the U.S. Department of Health and Human Services. For quality assurance and training purposes, this call may be monitored. We previously spoke about the MEPS study.
Did you receive the authorization form[s] we [faxed/mailed] to you?
[IF G1=1 and F1 = 1 (PHONE) GO TO G2;
IF G1=1 and F1 = 2 (FAX) OR 3 (MAIL) GO TO G4;
IF G1=2 OR 3, GO TO G5]
G2. If it is convenient for you, we can just go ahead and complete the data forms together over the phone right now. I’d be happy to hold on while you get the information you need from your records
[IF G2=1 GO TO EXIT SCREEN;
IF G2=2 GO TO G3]
G3. I understand. What would be the best day and time to call you back to complete the data forms?
DATE:
R’s TIME: AM/PM
TIMEZONE:
[IF COMPLETE, GO TO EXIT SCREEN]
G4. Our records indicate that you will [fax/mail] the records to us.
Please send in the complete 2016 records for each customer listed. The information we are attempting to collect from these records includes NDC, drug name, date filled, quantity dispensed, days supplied, and payments for each prescription.
When will you send us these records?
DATE:
IF DATE IS SELECTED REPEAT THE DATE AND THE DAY OF THE WEEK
OR
(NUMBER)
G4_1: Thank you. We will call you back if we do not receive the records by [FILL DATE FROM G4 (CALCULATE DATE IF DAYS/WEEKS ENTERED)].
YOUR NEXT STEPS WILL BE TO EXIT THE CONTACT GUIDE AND CODE THE CASE AS "AFs RECEIVED. WAITING FOR RECORDS TO BE SENT". THEN SET A CALL BACK AFTER THE RECORDS ARE EXPECTED SO WE CAN PROMPT AGAIN IF THEY STILL HAVE NOT BEEN RECEIVED.
GO TO EXIT SCREEN
G4_2:
INTERVIEWER: USE THIS SCREEN WHEN PROMPTING FOR RECORDS
We were anticipating receiving pharmacy records from you by [DATE/CALCULATED DATE FROM G4], but my records show we have not received them. Have you sent the records to us?
IF G4_2 = 2 GO G4_5
G4_3: How did you send the records? Did you fax, mail hardcopies via express or regular mail, mail CDs via express or regular mail, or use healthport?
IF POC IS SENDING CD: Was the password provided or did you send it separately?
G4_4: What date did you send them?
DATE:
Thank you for sending them. The records are received in a separate department and it can take a few days to upload the documents into our system. We will investigate and call you back if we have further questions. We apologize for any inconvenience.
INTERVIEWER:
NEXT WILL ROUTE TO EXIT SCREEN
G4_5
We need to obtain these records for the study as soon as possible. Is there something that can be done to speed up (or expedite) the process?
INTERVIEWER: LISTEN TO POC TO DETERMINE IF THERE IS ANYTHING WE CAN DO TO HELP FACILITATE THEM SENDING IN RECORDS. OFFER:
When will you send us these records?
DATE:
IF DATE IS SELECTED REPEAT THE DATE AND THE DAY OF THE WEEK
OR
(NUMBER)
Please send in the complete 2016 records for each customer listed. The information we are attempting to collect from these records includes NDC, drug name, date filled, quantity dispensed, days supplied, and payments for each prescription.
G4_6: Thank you. We will call you back if we do not receive the records by [FILL DATE FROM G4_5 (CALCULATE DATE IF DAYS/WEEKS ENTERED)].
INTERVIEWER: SET A CALL BACK AFTER THE RECORDS ARE EXPECTED SO WE CAN PROMPT AGAIN IF THEY STILL HAVE NOT BEEN RECEIVED.
GO TO EXIT SCREEN
G5. I’m sorry. Let me re-send the authorization form[s] to you.
I need to be sure I have the correct information for the packet. Should I direct it to you?
[IF G5=1, GO TO CONTACT BLOCK,
IF G5=2, GO TO CONTACT BLOCK]
H1. ASK (BY NAME) TO SPEAK WITH THE POC WHO DEALS WITH THE OTHER DEPARTMENT OR CORPORATE OFFICE
This is (YOUR NAME) calling on behalf of the U.S. Department of Health and Human Services.
For quality assurance and training purposes, this call may be monitored
We previously spoke about the MEPS study. Thank you for providing the contact information for [CORPORATE/DEPARTMENT NAME]. Unfortunately we were unable to locate [CORPORATE/DEPARTMENT NAME] with the contact information you provided. Could you please verify the contact information we currently have for [CORPORATE/DEPARTMENT NAME]?
[PRESENT CORPORATE/DEPARTMENT CONTACT INFO HERE]
[IF H1=1, GO TO H2,
IF H1=2, GO TO CONTACT BLOCK]
H2. That is currently the information we have on file. Do you know of any other way we can get in touch with [CORPORATE/DEPARTMENT NAME]?
[IF H2 = 1 GO TO CONTACT BLOCK,
IF H2=2 GO TO EXIT]
I1. ASK (BY NAME) TO SPEAK WITH THE POC WHO DEALS WITH THE OTHER DEPARTMENT OR CORPORATE OFFICE
This is (YOUR NAME) calling on behalf of the U.S. Department of Health and Human Services. For quality assurance and training purposes, this call may be monitored.
We previously spoke about the MEPS study. Thank you for providing the contact information for [CORPORATE/DEPARTMENT NAME]. We were able to locate [CORPORATE/DEPARTMENT NAME] with the information you provided. However, they reported that they did not maintain the patient profiles for [PHARMACY(S)] in 2016. Could you please check to see if another department maintained patient profiles for [PHARMACY(S)] in 2016?
[IF I1=1, GO TO CONTACT BLOCK,
IF I1=2, GO TO EXIT SCREEN]
PHARMACY NAME:
OTHER DEPARTMENT/CORPORATE OFFICE NAME:
POC FIRST NAME:
POC LAST NAME:
PHONE:
EXT:
TIME ZONE:
FAX:
VERIFY FAX:
E-MAIL:
TITLE:
DEPARTMENT:
ADDRESS:
CITY:
STATE:
ZIP:
CB1. WILL YOU BE CALLING THIS PERSON NEXT?
CB2. WHAT TYPE OF POC IS THIS PERSON?
CB3. WHAT TYPE OF PACKET ARE YOU SENDING?
CB3A: COMMENTS
CB4. ADD ANOTHER POC?
If the user indicated earlier in the contact guide that the provider has no billing service (B4=1), then the program will complete this screen and skip to Section F of contact guide to explain next steps to this provider POC. If the user indicated earlier that there is a billing service (B4=2), then the program will complete this screen and skip to Exit screen.
TYPICAL CONTACT SEQUENCE BY SECTION:
INTERNAL BILLING: A, B, Contact Block, F, end call
EXTERNAL BILLING SERVICE: Call provider: A, B, C, Contact Block, end call
Call billing service: D, E, edit Contact Block, end call
VERIFY AFs WERE RECEIVED: Go to G
[IF FIRST RADIO BUTTON IS SELECTED, GO TO B1.
IF SECOND RADIO BUTTON IS SELECTED, GO TO C1.
IF THIRD RADIO BUTTON IS SELECTED, GO TO D1.
IF FOURTH RADIO BUTTON IS SELECTED, GO TO G1.]
Can you please provide me with a better time to call back in order to reach him/her?
[ALL GO TO EXIT SCREEN FROM HERE]
PRESS FINISH TO EXIT CONTACT GUIDE AND GO TO CASE MANAGEMENT SYSTEM.
DO NOT HANG UP UNTIL YOU GET TO CALL DISPOSITION SCREEN.
IF POC RECEIVED AUTHORIZATION FORMS AND CAN REPORT DATA BY PHONE NOW, ENTER EVENT CODE 441: AFs Received-Ready for Data Collection
IF YOU NEED TO SEND A COURTESY OR PERMISSION PACKET:
[EXIT TO CMS BY PRESSING FINISH, BREAK-OFF SHOULD BE A SEPARATE FUNCTION.]
INTRODUCTION:
May I please speak to [POC NAME]?
Hello, my name is (YOUR NAME).
I am calling on behalf of the U.S. Department of Health and Human Services. We are conducting MEPS which is a study about how
people in the United States use and pay for health care. For quality assurance and training purposes, this call may be monitored.
I recently spoke with {POC YOU ARE WORKING WITH FOR DATA COLLECTION} about the study. I explained that at this time, [NUMBER FROM PATIENT LIST] patient[s] identified [PHARMACY] as a place where they received prescribed medication during 2016. [The/Each] patient signed an authorization form allowing us to contact you for information about the prescribed medication they received from [PHARMACY] in 2016. Much of the information we need is within the patient profiles.
{POC YOU ARE WORKING WITH FOR DATA COLLECTION} has agreed to participate and provide us with the information we are looking for, but has requested that we first send you a copy of the authorization form[s] in order to receive permission to release the data to us.
I’m calling to confirm that you are in fact the best person to receive the form[s] and information about the study by fax, and confirm your contact information so that I can address the fax to you.
[GO TO CONTACT BLOCK]
VERIFY PERMISSION PACKET RECEIPT:
May I please speak to [POC NAME]?
(Hello, my name is (YOUR NAME).) I am calling on behalf of the U.S. Department of Health and Human Services. We previously spoke about the MEPS study. For quality assurance and training purposes this call may be monitored. Did you receive the authorization form[s] we sent to you?
[NEXT TAKES USER TO CONTACT BLOCK]