Conference Call or Quote Request for Dental Claims Cleanup, LLC or Results! Dental Collections, LLC

Thank you for contacting us. We would like to setup a conference call to discuss your dental billing, debt collection, and other financial support services. To make the most of the call and for us to be able to provide you with a quote for service, please provide us with the information requested.

average number of claims submitted per month
total claims aging over 30 days
# of claims on the report
total accounts receivable (patient and insurance) over 30 days
# of patient balances on the report

Thank you again. We are looking forward to our call and to help your practice.

"Consumer information is not shared with third parties for marketing purposes."

Always on Your Side,

Dr. Dorothy Kassab

800-652-3431

or email dkassab@kassabenterpriseteam.com

Tell Us About You

what type of dental office do you have?

Date

mm/dd/yyyy

Your First Name

Your Last Name

Office Phone Number

Office or Your Email

Position at the office

Doctor's First Name

Doctor's Last Name

Doctor's Email

Doctor's Cell Number

Practice Name

Dental Office Street Address

Practice Website

Newsletter Sign-up Request

How did you hear about us?

Date you are available for a conference call MON-FRI: DATE

mm/dd/yyyy

What TIME would you like us to reach you?

TIME ZONE

Tell Us More About Your Practice

What Dental Software do you use?

How many days is your practice open?

# Monthly Claims

How many claims does your office submit per month on average?

$ Insurance AR

DO you know what your current total over 30 days insurance aging is?

$ Balances AR

WHat is your current patient balances accounts receivable?

outstanding A/R

Total outstanging AR

Current collection company name?

Do you currently use a collection agency? Which one?

Which of our services are you Interested in?

We provide ongoing dental billing services through Dental Claims Cleanup AND seamless submission to our debt collection through our Results! Dental Collection Services. Are you interested in one of these or both?

In addition we can support your practice with

Medical Billing

Verification

Credentialing

Service Interest

What services are you interested in?

What are your current struggles?

What are the current struggles in your practice. Please tell us what you are noticing. Sometimes, the owner Dentist does not really know what the problem is but they do see the indicators of a problem. What are those signs?

Please feel free to share with us your reports if you want us to obtain the numbers.

Drop your files here

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