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Fields marked with * are mandatory
* Name
* Email
* No of physicians in the practice
* Specialty(s) with number of physicians in
   each specialty
* No of Procedures performed per day
* Total Collection per month
* Total no of bills generated per month
* Average billed amount of a claim
* Average number of line items per claim
* Payor Mix (in %) - Medicare / Medicaid /
   BCBS / Commercial / WC/Self pay/Others
* % of electronic to manual postings
   in daily payment posting volumes.
* % of denials on the number of claims
    generated and on $ value claimed.
   Software used for billing
   Modality for pick up of input documents?
   Do we file secondaries from India?
   Connectivity details
* Aged AR: 30-60 days

60-90 days

90-120 days

120-150 days

More than 150 days

* Verification Code