Independent Medical Bill Advocacy
Harmony Health Services are client funded. We do not work for the provider or insurance company.
Client full legal name
*
First Name
Last Name
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email address
example@example.com
Client City
Client State
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Preferred contact method
Phone
Email
How can Harmony Health LLC assist?
*
Out-of-network claim help
Denied or rejected claim
Appeal help
Medical bill or EOB review
Provider/facility name
State where services were provided
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Primary insurance company
Secondary insurance (if any)
Is the provider believed to be out of network?
Yes
No
Unsure
Have claims already been submitted?
Yes
No
Has the client received an EOB or denial?
Yes
No
What documents does the client currently have?
Itemized bill
EOB
Medical record
If accepted, move the client to the Harmony onboarding/signature packet. Detailed coding, claim build, line-by-line audit, submission, follow-up, denial, appeal, and payment reconciliation are tracked in the Medical Billing Advocacy Case Workbook.
Comment box
Submit
Should be Empty: