EDI File Submission/Retrieval
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Contact Us
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Administrator Only
How to contact us:
Use ,HELP
E-mail:
[email protected]
Phone: 949.255.2616
Fax: 949.255.2605
Our Mailing Address:
18191 Von Karman Ave. Suite #450
Irvine, CA 92612
Request Information
Please complete the information below and submit this form. You will be contacted by a Sales Consultant within a few business days.
I am interested in
- select topic -
Eligibility
Voice Reminder
Statements
Letters, Cards
ERA
Direct Deposit
Claims/Encounters
Name
*
Organization/Practice
*
Phone
*
E-mail
*
Number of Doctors
Current Eligibility Process
- please select -
Staff Calls
Use Carrier Website
Not Verified
If selected "Staff Call" or "Use Carrier Website", please specify % Verified
Estimated Claims Denied
Largest Payors
Current Method of Statement Processing
Monthly Statement Volume
Mailing Cycle
- please select -
Daily
Weekly
Monthly
Other
If other, enter
Number of Appointments per Month
Current Method of Reminder Process
- please select -
Patients Not Contacted for Reminders
Post Card/Letters
Staff Calls Patients
Automated System
Current No Show Rate
Letter or Card Types
- please select -
Appointment Reminders
Recalls
Collection
Payment Requests
Birthday Greetings
Clinical Follow up/Results
Other
If other, enter
Est. Monthly Volume of Letters
Est. Monthly Volume of Cards
Mailing Cycle
- please select -
Daily
Weekly
Monthly
Other
If other, enter
Current Primary Claims Process
- please select -
Direct to Payers
Clearinghouse
Paper
Combination
Other
Details About Claims
Estimated Number of Claims
Largest Payors
Est. Number of Claims for Payors which Supply ERA
Est. Number of Hours per Week Spend Posting Claims for These Payors
Estimated Number of Mail Payments
Monthly Volume
% of Mail Credit Card Payments
Do you currently use a lockbox?
- please select -
yes
no
If No, Est. # Hours Per Week Spent Posting Mail Payments & Making Bank Deposits
Current Primary Claims Process
- please select -
Direct to Payers
Clearinghouse
Paper
Combination
Other
Details About Claims
Estimated Number of Claims
Estimated Claims Per Month
Largest Payors
Specialty(ies)
Desired Live Date
Primary Objective/Special needs/Comments
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Comments/Suggestions:
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Version 2.0.
Release Note
