BRUSH Advantage Pilot Provider Survey

B.R.U.S.H.^® Advantage Pilot Provider Survey Questions

Who needs to fill out the questionnaire: To be filled out by any dentist/staff member that is filling out the CAPRA forms.

Office Name

Office Address

Name of person filling out survey

Our records indicate that you are enrolled in LIBERTY’s Value Based B.R.U.S.H.® Advantage Program. We would like to know if you actively submitting CAPRA forms for the Anthem Medicare Advantage members through LIBERTY’s secure portal?

Yes

If yes, please move to Program Administration questions below.

If you answered No, you do not need to complete survey. A LIBERTY Dental Plan Network Manager will be contacting your office.

Program Administration

1. Have you submitted a CAPRA form through LIBERTY’s secure portal?

Yes

If No, please select one of the following from the drop down:

2. How long did it take you to review the questions with the member?

5 minutes or less

More than 5 minutes

3. Was the CAPRA form easy to fill out?

Yes

Are you having any issues using the portal and accessing the CAPRA form?

Yes

Would you like a Network Manager to contact your office?

Yes

6. Do you or any of your staff members need additional training on LIBERTY’s B.R.U.S.H.® Advantage Program or how to submit a CAPRA form?

Yes

7. What dental software does your office currently use?

8. Is there additional feedback regarding the B.R.U.S.H.® Advantage program that you would like to share with LIBERTY?

Please only click Submit once

B.R.U.S.H.® Advantage Pilot Provider Survey Questions

B.R.U.S.H.^® Advantage Pilot Provider Survey Questions