Provider Demographics

As a participating plan of the South Carolina Healthy Connections Prime Medicare-Medicaid program, we are required to provide our Healthy Connections Prime members with access to medical programs and services. We are required to reasonably accommodate enrollees and ensure programs and services are as accessible (including physical and geographic access) to individuals with disabilities as they are to individuals without disabilities. Accordingly, we will inform enrollees of a provider’s ability to accommodate special needs through the provider directory. Through a system of icons in the provider directory, enrollees will be able to identify specific levels of accommodations at provider sites. Please visit our website and verify that your provider demographics are correct in our online provider directory at www.firstchoicevipcareplus.com

Question Title

* 1. Practice Name and Tax ID#:

Question Title

* 2. I have confirmed that all provider information (group name, provider's name, address, phone numbers, etc.) in the online provider directory (accessible from www.firstchoicevipcareplus.com) is correct for all providers associated with this tax ID number.

Question Title

* 3. Provider Fax Number:

Question Title

* 4. Individual Completing the Survey:

Question Title

* 5. Email address the office would like to receive electronic communications:

Question Title

* 6. Please confirm the practice hours of operations. (Click on the opening and closing time for each day.)

  24/7 Closed 6 AM 7 AM 8 AM 9 AM 10 AM 11 AM 12 PM 1 PM 2 PM 3 PM 4 PM 5 PM 6 PM 7 PM 8 PM
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Question Title

* 7. Do/can you provide alternative appointment scheduling for those who need extra time, extended hours or home visits?

Question Title

* 8. Please list the specific languages spoken by the provider(s) or staff.

Question Title

* 9. Do any of the providers in your office have special experience, skill, expertise, or training in treating persons with: trauma, child welfare, substance use, physical disabilities, chronic illness, HIV/AIDS, serious mental illness, homelessness, deafness or hard-of-hearing, blindness or visual impairment, co-occurring disorders, or other area of specialty? Select all that apply:

Question Title

* 10. Is your practice location available by public transportation?

Question Title

* 11. Has the provider or staff completed disability and cultural competency training?

Question Title

* 12. Does the provider's location offer any of the following?

Question Title

* 13. Do you accommodate services, teaching materials, and documents for individuals with learning, intellectual and/or cognitive disabilities?

Question Title

* 14. Are printed materials made available in alternative formats?

Question Title

* 15. Do you provide any of the following accommodations to ensure effective communication with hearing-impaired individuals?

If you have any questions about this survey please contact Provider Services at 1-888-978-0862. Thank you for providing this valuable information.
( Privacy & Cookie Notice

T