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OTPI Intake Form
Hello! We look forward to the possibility of setting up an amazing partnership with you. Our goal is to help you with all the things that keep you up at night regarding billing and collections with Prompt. Please take a few minutes and fill out the questions below.
* Indicates required question
Please choose the best answer
I am already with Prompt and would like to bring billing in house
I have signed up with Prompt however have I not yet gone live
I am still deciding whether Prompt and inhouse billing is right for my practice and have some questions
I would like to learn more about what you do and services that you offer
Other:
Clear selection
Name of business owner. (if not the responsible party please write that person's name here as well)
*
Your answer
Name of Company
Your answer
Phone number of business owner
*
Your answer
Best days and times for an Introductory Call
*
Your answer
Email of business owner
*
Your answer
Company address
*
Your answer
Address of main contact if different than above
Your answer
What state or region(s) do you bill out from?
*
Your answer
How many years in business?
*
Your answer
How many claims do you bill out per week?
Your answer
What is your average reimbursement per claim?
Your answer
Have you done billing in house before?
*
Yes
No
Are you planning on billing inhouse with Prompt?
*
Yes
No
Maybe
Do you currently employ a person who will be doing your billing?
Your answer
What is your current denial rate (if you know it)?
Your answer
How many hours do you or your current biller/ admin person spend on billing, collections, and denials per week?
Your answer
What are the main concerns that you would like help with? (Select All that apply)
*
AR/ collections
Denials
Billing/ coding
Reports
Front Office SOPs (Standard Operating Procedures)
Clinician SOPs
General Prompt efficiencies
KPI (Key Performance Indicators) analysis
Other:
Required
If you have an idea about when you would like to start improving your billing through Prompt or you have a Prompt "Go Live" date please let us know that date.
Your answer
Is there anything else that you would like us to know?
Your answer
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