Free Evaluation

Free Evaluation

If you wish to contact us, we can be reached at:
Phone: 877-404-2300
Fax: 732-404-1556
Email: info@healthquist.com

The following is an online evaluation – after you are finished filling the form out, please press submit at the bottom of the screen.

Personal Information :

Personal Information :
Name		Name of Practice
Email		Phone
Fax		Best time to contact
Contact Person		Contact Phone
Address #1		Address #2
City		State
Zip		Comments
Specialty Type
Practice Information :
We have an: In-house Staff Billing Company
File Claims Electronically: Yes No
Number of Providers in Practice: 1 2 3-5 6 or more
Approximate number of patients seen per month: 50-100 100-200 200-500 500 or more
Current Cost of Billing:
Weekly cost of In-House Staff:
Monthly cost of Billing Service :
Insurance Information
What is your average turnaround on insurance claims? 15-30 days 30-60 days 60-90 days Over 90 days
Approximate percentage of unpaid claims due to filing errors: 5% 10% 15% Over 20%
Approximate percentage of claims uncollectable: 5% 10% 15% Over 20%
Average Value per claim:
How do you feel about your present method for billing? Satisfactory Needs Improvement Unsatisfactory