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?

Full Practice Management Claims Only HIPAA Consulting A/R Management/Cleanup Patient Reimbursment Solutions Software Sales and Training Only All of the Above Not Quite Sure
 

 What is your current billing setup?

In-House Billing
Outsourced Billing
New Practice
 

 How many providers are in your office?

Single Provider Practice 2-5 5 or more
 

What percentage of claims are Medicare?

Less than 50% 50% or more
 

What percentage of claims are Blue Cross/Blue Shield?

        Less than 50% More than 50%  

What percentage of claims are Medicaid?

       Less than 50% More than 50%

How would you like us to contact you?

Phone Email Fax Mail Information     Contact Person Name

Best Time to contact you? 

 

How are you filing claims now? 

On Paper Electronic Billing Center, unhappy

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.