After you have chosen ADB as your medical billing service, the following information is all that we need to begin setting up your practice in our system
in order to represent you. We will provide you with pre-paid envelopes to mail your cases to us every week or provide you with instructions to send them to us via encrypted scan.
For every patient that you see, we will need (ideally):
1) A patient demographics page containing the name, address, SS#, dob, etc.
2) Copies of the patient's health insurance card(s).
3) Superbill or charge sheet, including narrative of the procedure and
diagnosis.
4) Copy of the anesthesia record.
To the extent that all of this information might not be conveniently available
for your to provide, we can almost always work with what you have.
In addition to the information that we are requesting on the Start-Up Information Sheet, we need copies of the following documents:
Copy of State Medical License
Copy of DEA License
Copy of current Malpractice Insurance cover page
List of any special procedure codes having fixed fees
List of all insurance companies you are participating/contracted with
*******************************
NOTICE: Completing the following page will not automatically transmit your data to our office online.
This is not a "secure" web site and we do not
wish to transmit such confidential information unencrypted. Once you complete the fields with your answers, you will be given the option of printing the completed form from your printer. That form, along with your credentialing documents, can then either be mailed or emailed (encrypted) to our office. Our mailing address and email address will be shown on the following page after you "click" below for the Start-Up Form.
If you prefer to fill in the form offline, choose the Open Form button and you can save or print it from your browser window. |
