Compliance Survey

Please fill out the following survey, so we can properly assess your compliance requirements and your audit readiness. Once we receive your survey, a compliance specialist will review it and will contact you with recommendations on how we can assist you with your compliance requirements.

Contact Information:

First Name: *

Last Name: *

Phone: *

Email: *

Survey Question 1:

Do you, or a third party billing company or clearinghouse, conduct any one of the following business transactions electronically?

Claims or equivalent encounter information.
Payment and remittance advice.
Claim status inquiry/response
Referral authorization inquiry/response

Answer:

Yes No

Survey Question 2:

Do you, or a third party billing company or clearinghouse, conduct any one of the following business transactions electronically?

Claims or equivalent encounter information.
Payment and remittance advice.
Claim status inquiry/response
Referral authorization inquiry/response

Answer:

Yes No

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