Consulting / Medical Billing Services Inquiry
Company Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Fax Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Website
Owner/CEO Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
example@example.com
What EHR Software are you currently using?
*
Are you satisfied with it?
*
Yes
No
N/A
Is the organization accredited?
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Yes
No
Applied and Scheduled
N/A
What accrediting organization was chosen?
Have you ever outsourced your billing before?
Yes
No
How many times per week are you currently billing?
*
What kind of billing issues are you having, if any?
*
How many clients/patients do you have?
*
How many providers do you have?
*
How many locations do you have?
*
Tax ID
*
NPI
*
CAQH
What insurance companies are you credentialed with?
*
What services do you provide?
*
To help us get to know your organization...
Upload a brochure or any marketing material describing your services.
Browse Files
Preferably PDF format
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Describe the structure of your organization.
How else can we help you?
Are there any additional services you may be interested in?
Management
Training
CPR
Credentialing
Admin Services
Any services not listed that you may need assistance with?
What are your expectations of Exceptional Medical Services?
Enter the message as it's shown
*
Email
example@example.com
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