Your Name

Practice Name

Full Practice Management Claims Only Custom Service Options 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%  

How would you like us to contact you? Phone Email Fax Mail Information

    Contact Person Name: 

How are you filing claims now?  On Paper Electronic Billing Center, unhappy

How many claims are you filing per month? 

How much is the average amount of a visit?

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