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*First Name
*Last Name
*Title/Specialty
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*Street Address
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*City
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 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 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  

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 billed amount per claim? 

How many patients are seen per day? 

Do you experience a lot of rejections?

Do you currently have a backlog of claims?

Press the Submit button when you are finished, a Billing Specialist will get back to you within 24 hours.  Thank you for taking a moment to fill out this form.