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HIPAA

     P.O. Box 141
     Tok, AK 99780

     Phone:
     (907) 505-0083

     Fax:
     (866) 611-7060

     Email:
     medicalbilling@chickadee.net


     How does this work?

Questionairre

Fill out the questionnaire below and click the submit button when completed. All of the fields are required, except for the comment field, so that we can provide you with a complete FREE Quote and personalized package of information.

Contact Information:

Practice Name
Contact Name
Email
Phone	Fax
Best time to contact
Address
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Zip
Specialty Type

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Practice Details:

Who currently does your billing? In-house Staff Billing Company

Do you file claims electronically? Yes No

What's the number of Providers in your Practice? 1 2 3-5 6 or more

What's the approximate number of patients seen per month? 50-100 100-200 200-500 500 or more

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Current Cost of Billing:

Weekly cost of In-House Staff:

Monthly cost of Billing Service:

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Insurance Information:

What is your average turnaround on insurance claims? 15-30 days 30-60 days 60-90 days Over 90 days

What is the approximate percentage of unpaid claims due to filing errors? 5% 10% 15% Over 20%

What is the approximate percentage of claims that are uncollectable? 5% 10% 15% Over 20%

What's the average value per claim?

How do you feel about your present method for billing? Satisfactory Needs Improvement Unsatisfactory

Comments