Getting Started

Ready for no-cost, no-obligation consultation?
Please call us toll-free at (877) 924-7797.
Or if you prefer, complete the questionnaire below so that we can better understand your practice, and we'll get back with you right away.

Not quite ready for a consultation, but you still have some questions about our service? Please go to the Email Us page, and we will be happy to respond.

The information collected will be used only by Emax Medical Billing LLC.
* Indicates a required field.
* Type of provider:
Specialty?
* Name of your practice or ambulance service:
NPI:
* Your full name:
* Address line 1:
Address line 2:
* City:
* State:
* Zip code:
* Phone number
Fax number:
* Best time to call:
* Email address:
Provider web address
* Current method of billing

Please answer the questions below as best you can. If you don't have the actual data, or if you are starting a new practice, it's okay to provide estimates. Likewise, if you represent an ambulance service that has not done insurance billing in the past, just tell us about the number of runs you make per year in the text box at the bottom of this form.
* Annual practice revenue:
* Number of providers in practice:
* Number of patient encounters per year:
* Percentage of Medicare patients:
* Percentage of Medicaid patients:
* Percentage of cash patients:
* For diagnosis coding, I prefer to provide: ICD-9 numeric codes only.
Descriptions only.
Combination of descriptions and ICD-9 codes.
* My answers above:
Please tell us anything more that might help us better understand your practice: