Pricing Inquiry Form

Is your office staff spending endless hours submitting medical claims or tracking payments? Is your office submitting claims on HCFA forms instead of electronic? It may be time to consider outsourcing your insurance billing to a qualified medical billing service. Please fill out the following form and we will contact you shortly regarding your inquiry.

The benefits of outsourcing include the following:

	All EOB's and checks go directly to your office
	Follow up on unpaid claims available when needed
	Fast Turn Around on your claims
	We help overturn denied claims
	Reduce the burden of stalled claims

When you are finished, click on the Submit button to send the form to us via email. We will contact you within 48 hours after we receive your submission. If your browser does not support forms, please contact us so we can get back to you with the information you are requesting.

Contact Name Practice Name Mailing Address Line 1: Mailing Address Line 2: City, State, and Zip/Postal Code: ***Please double check phone number and and email address to be sure they are valid, or we will not be able to contact you.*** Phone Number: Fax Number: E-mail address: How do you prefer to be contacted? email phone If phone, what is the best time of day to reach you? Describe Your Type of Medical Practice: What Type of Medical Practice are you Currently Using? Questions or Comments: