| 708-448-8178 | karebilling@sbcglobal.net |  Palos Park, Illinois  |

 


 

 

 

 

 

 
First Name  
*Last Name  
*Title/Specialty  
Organization  
*Street Address  
Address (cont.)  
*City  
*State/Province  
Zip/Postal Code  
Country  
*Work Phone  
FAX  
*E-mail  
URL  

 What type of services are you looking for?


 

 What is your current billing setup?

In-House Billing
Outsourced Billing
New Practice
 

 How many providers are in your office?


 

What percentage of claims are Medicare?


 

What percentage of claims are Blue Cross/Blue Shield?

         

What percentage of claims are Medicaid?

      

 

How would you like us to contact you?

    Contact Person Name

Best Time to contact you? 

 

How are you filing claims now? 



How many claims are you filing per month? 

What is your average receivables per visit?

Press Submit button when you are finished and a Billing Specialist will get back to you within 24 hours.

 

 


 
 
 
 
 
 
 
 
 
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