Medical Bill PREVIEW

Rather than reacting to a bill after services have been rendered, allow us to be proactive and pre-negotiate pricing when the request for authorization has been obtained. Simply submit the following information and allow us to negotiate the pricing with the non-PPO vendor.

* All fields required unless (optional).

Payor Information *

Adjuster    Case Manager

DME/Home Health Vendor Information *

Claimant/Applicant Information *

DME/Home Health Quote Details *

  Quoted price from DME Vendor:  $
  Quoted price from DME Vendor:  $
  Quoted price from DME Vendor:  $
  Quote from Home Health Vendor:  $
I agree to the terms of conditions of the submitting a quote.
Quote request submitted!
Medical Bill PREVIEW