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Practice name *

Your name *

Role *Owner / physicianOffice managerBilling managerAdministratorOther

Email *

Phone

Practice type *ChiropracticPhysical therapyRehab / therapy specialtyPain managementPrimary careOther specialty

State *

Some requests may need a quick fit and availability review before we confirm next steps.

How many providers are in the practice? *12-34-78+Not sure

in support? is

Approximate monthly visit or claim volumeUnder 100100-300301-750751+Not sure

What is the biggest billing problem right now? *

• Aging AR / money sitting too long
• Denials
• Verification of benefits / eligibility issues
• Prior auth problems
• Credentialing or enrollment delays
• Payment posting / reconciliation confusion
• Current billing company is not communicating clearly
• In-house billing team is overloaded
• Reporting is unclear
• Other

How urgent is this? *

• Need help this week
• Need help this month
• Exploring options for later
• Just gathering information

What would make this review useful? *

Share the operational issue in general terms. Do not include patient names, claim numbers, dates of birth, or other patient-specific information.

Who handles billing today? *In-house teamOutside billing companyMix of in-house and outside helpNot sure / changing soon

Are you considering changing billing support? *

• Yes, soon
• Possibly
• Not yet, but we need better visibility
• No, just need education

What matters most in a billing partner? *

• Communication and visibility
• Faster follow-up on AR
• Denial prevention and follow-up
• Better reporting
• Specialty knowledge
• Credentialing/enrollment support
• Lower cost
• Other

No patient information acknowledgment *

• I understand this form is for general practice and billing-process information only. I will not include patient names, dates of birth, claim numbers, chart numbers, or other protected health information.

Permission to contact *

• Aloha Management may contact me about this request using the information I provided.

Request My Review

Reminder: please use general practice/business details only.

Before you send

Aloha can review practice-level workflow concerns, but public web forms should not receive patient-level information.