Basic Information

Name^*

Your Email^*

How do you want to receive quote?^*

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Contact Details

Share your contact number^*

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Location Details

State

Zip code^*

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Practice details

Practice name

Specialty^*

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Providers

Number of providers in the practice^*

Average number of patients per month^*

Do you currently have a billing system in place?^*

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Specific Requirements

Describe any deal breakers or critical success factors for your billing needs

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Service and Provider Preferences

What services are you looking for in a medical billing partner?

Claim Submission

Billing and Reconciliation

Patient invoicing and follow -up

Compliance Management

Reporting and Analytics

Medical coding

End-to-End RCM Solution

Preference for billing team location^*

Do you require integration with electronic health records (EHR)?

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Financial Considerations

What is your budget or current spending on medical billing?

Have you received any quotes from other billing services?

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How Urgent?

What is your timeline for (switching / hiring) a new billing partner?

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Additional details

Are there any specific features or capabilities you are looking for?

Please describe any specific needs or considerations for your practice’s billing requirements

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Support

Need I-medical billing's scheduling team's support? (No Charge)

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