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Personal Information

Salutation

First Name

Last Name

Your Roles (check all that apply)

Doctor/Provider

Bookkeeper

Biller

Administrator

Other

(specify)

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Organization Information

Organization Name

Mailing Address

City

State

Zipcode

Phone

Email Address

Please describe your organization. (check all that apply)

Private Practice

(specialty)

Transportation

Home Health

Billing Service

DME

Hospital

Long-Term Care

Other

(specify)

Claims and Billing Information

How do you bill for services? (check all that apply)

Professional Claims (CMS)

(no./month)

Institutional Claims (UB)

(no./month)

Patient Statements

(no./month)

How do you currently handle claims? (check all that apply)

We submit through a clearinghouse

We print and mail paper claims

We submit via the payer's website

We send directly to medicare via dialup

We use a billing service

What are your current needs? (check all that apply)

We already have software for electronic billing.

We want to keep our existing practice management software but need a better solution for claims.

We need a better system for electronic claims and patient billing.

We don't have a true accounts recievable system but would like to integrate our claims and patient billing.

Questions?

FastEMC

HIPAA-compliant claims. Prompt payment. Everytime.

Request Information

Your Roles (check all that apply)

Please describe your organization. (check all that apply)

How do you bill for services? (check all that apply)

How do you currently handle claims? (check all that apply)

What are your current needs? (check all that apply)