Q25 In the last 6 months, how often did you get an appointment to see a specialist as soon as you needed? 1 = never 2 = sometimes 3 = usually 4 = always 7 = appropriately skipped 8 = multiple marks 9 = missing Number Yes N/A Q26 How many specialists have you seen in the last 6 months? 0 = none 1 = 1 2 = 2 3 = 3 4 = 4 5 = 5+ 7 = appropriately skipped 8 = multiple marks 9 = missing Number Yes N/A Q27 Using any number from 0 to 10, what number would you use to rate the specialist you have seen most often in the last 6 months? 00=worst ... 10=best 77=appropriately skipped 88=multiple marks 99=missing Number Yes N/A Q28 In the last 6 months, did you look for any information in written materials or on the internet about how your health plan works? 1 = yes 2 = no 8 = multiple marks 9 = missing Number Yes N/A Q29 In the last 6 months, how often did the written materials or internet provide the information you needed about how your health plan works? 1 = never Number Yes N/A
Q56b What is your race? Mark one or more. 0 = NO for "Black or African American" 1 = YES for "Black or African American" Number Yes N/A Q56c What is your race? Mark one or more. 0 = NO for "Asian" 1 = YES for "Asian" Number Yes N/A Q56d What is your race? Mark one or more. 0 = NO for "Native Hawaiian or other Pacific Islander" 1 = YES for "Native Hawaiian or other Pacific Islander" Number Yes N/A Q56e What is your race? Mark one or more. 0 = NO for "American Indian or Alaska Native" 1 = YES for "American Indian or Alaska Native" Number Yes N/A Q56f What is your race? Mark one or more. 0 = NO for "Other" 1 = YES for "Other" Number Yes N/A Q57 Did someone help you complete this survey? 1 = yes 2 = no 7 = appropriately skipped 8 = multiple marks 9 = missing Number Yes N/A Q58a How did that person help you? 0 = NO for "Read the questions to me" 1 = YES for "Read the questions to me" Number Yes N/A Q58b How did that person help you? 0 = NO for "Wrote down the answers I gave" 1 = YES for "Wrote down the answers I gave" Number Yes N/A Q58c How did that person help you? 0 = NO for "Answered the questions for me" 1 = YES for "Answered the questions for me" Number Yes N/A Q58d How did that person help you? 0 = NO for "Translated the questions into my language" 1 = YES for "Translated the questions into my language" Number Yes N/A Q58e How did that person help you? 0 = NO for "Helped in some other way" 1 = YES for "Helped in some other way" Number Yes N/A
0 = NO for "Answered the questions for me" 1 = YES for "Answered the questions for me" Q83d How did that person help you? 0 = NO for "Translated the questions into my language" 1 = YES for "Translated the questions into my language" Number Yes N/A Q83e How did that person help you? 0 = NO for "Helped in some other way" 1 = YES for "Helped in some other way" Number Yes N/A CAHPS - Child/CHIP without CCC FIELD NAME FIELD DESCRIPTION FIELD TYPE REQUIRED FIELD REQUIREMENTS AND MASKS ID Assigns unique ID to everyone receiving a CAHPS survey, regardless of whether or not survey was returned Number Yes N/A Mode M10/T10/W10 = Completed Survey M20/T20 = Ineligible(deceased) M21/T21/W21 = Ineligible(does not meet criteria) M22/T22 = Ineligible(language barrier) M23/T23 = bad address or phone number M32/T32 = Nonresponse(refusal) M33/T33 = Nonresponse(max attempts) Short Text Yes SIZE: 3 characters Round M1/M2/M3 = Responded to 1st/2nd/3rd mailing attempt T1/T2/T3 = Responded to 1st/2nd/3rd phone attempt MT = Partially completed by mail then phone W1 = Completed by internet WT = Partially completed by internet then phone NC = Not completed Short Text Yes SIZE: 2 characters Language 1 = English 2 = Spanish 3 = N/A Number Yes N/A State of Residence Two-letter state abbreviation (i.e., NE = Nebraska) Short Text Yes N/A
BirthYear Enter in YYYY format Number Yes N/A Sex 1 = male 2 = female 9 = missing Number Yes N/A Child Population 1 = Medicaid (General) 2 = CHIP Number Yes N/A Q1 Our records indicate that your child is now in {insert health plan name}. Is that right? 1 = Yes 2 = No 8 = Multiple Marks 9 = Missing Number Yes N/A Q2 Open response/possibly no response depending on answer 1 Short Text Yes N/A Q3 In the last 6 months, did your child have an illness, injury, or condition that needed care right away in a clinic, emergency room, or doctor's office? 1 = Yes 2 = No 8 = Multiple Marks 9 = Missing Number Yes N/A Q4 In the last 6 months, when your child needed care right away, how often did you get care as soon as you needed? 1 = Never 2 = Sometimes 3 = Usually 4 = Always 7 = Appropriately Skipped 8 = Multiple Marks 9 = Missing Number Yes N/A Q5 In the last 6 months, did you make any appointments for your child for a check-up or routine care at a doctor's office or clinic? 1 = Yes 2 = No 8 = Multiple Marks 9 = Missing Number Yes N/A Q6 In the last 6 months, how often did your child get an appointment for a check-up or routine care at a doctor's office or clinic as soon as you needed? 1=Never Number Yes N/A
Q24 In the last 6 months, did your child get care from a doctor or other health provider besides his/her personal doctor? 1 = yes 2 = no 7 = appropriately skipped 8 = multiple marks 9 = missing Number Yes N/A Q25 In the last 6 months, how often did your child's personal doctor seem informed and about the received from these other health providers? 1=never 2=sometimes 3=usually 4=always 7=appropriately skipped 8=multiple marks 9=missing Number Yes N/A Q26 Using any number from 0 to 10, what number would you use to rate your child's personal doctor? 00=0 01=1 ... 10=10 77 = appropriately skipped 88 = multiple marks 99 = missing Number Yes N/A Q27 In the last 6 months did you make any appointments for your child to see a specialist? 1 = yes 2 = no 8 = multiple marks 9 = missing Number Yes N/A Q28 In the last 6 months, how often did your child get an appointment to see a specialist as soon as needed? 1 = never 2 = sometimes 3 = usually 4 = always Number Yes N/A
Resolution Date Date the Appeal/Expedited Appeal/State Fair Hearing was resolved Date/Time No REQUIRED IF AND ONLY IF: “Type of Issue” is “Appeal”, “Expedited Appeal”, or “State Fair Hearing” Resolution Outcome CHOOSE: Upheld Overturned Withdrawn Partially Overturned Dismissed Unresolved Short Text No REQUIRED IF AND ONLY IF: “Type of Issue” is “Appeal”, “Expedited Appeal”, or “State Fair Hearing” Denial Type CHOOSE: Durable Medical Equipment Therapy Services Procedure in Physician Office Outpatient Procedures Inpatient Procedures Home Health Services Radiology Pharmacy Vision Benefits Other Short Text No REQUIRED IF AND ONLY IF: “Resolution Outcome” is “Upheld” Denial Reasoning Description of the rationale given for upholding denial Long Text No REQUIRED IF AND ONLY IF: “Resolution Outcome” is “Upheld” Other Denial Type Description Short description of the type of “other” denial Short Text No REQUIRED IF AND ONLY IF: “Denial Reasoning” is "Other" Reason Unresolved Short description of the reason the appeal/expedited appeal/state fair hearing is unresolved Short Text No REQUIRED IF AND ONLY IF: “Resolution Outcome” is "Unresolved" Provider First Name First name of the provider on the grievance Short Text Yes N/A Provider Last Name Last name of the provider on the grievance Short Text Yes N/A NE Medicaid Provider ID Provider’s NE Medicaid ID number Short Text Yes N/A Provider NPI Provider’s NPI ID number Short Text Yes N/A Procedure Code If a procedure is a part of the grievance, list the code of the procedure Short Text No N/A