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1777 Reisterstown Road
Suite 330
Baltimore, MD 21208
Phone: 800.329.0365 | 410.653.0194
Fax: 410.653.9969

Services Request Form

Please provide the following contact information:

NAME  
TITLE  
ORGANIZATION  
CITY  
STATE  
WORK PHONE  
FAX  
EMAIL  

Indicate the services you are interested in:

Remote Coding   Radiology Physician Liaison
Onsite Coding   Cancer Registry
IP Coding   Trauma Registry
OP Coding   Data Collection and Abstraction
ED Coding   Master Patient Index
Radiology Coding   Interim Management
ASC Coding   HIM Operational Review
Coding Compliance/Data Quality Review    Other, please specify:
Coding Education      

Indicate the scope of services:

Total or partial outsourcing of coding
PRN coding
Periodic audits and reviews
One-time audit and review
Other type of project


 


1777 Reisterstown Road  • Suite 330  •  Baltimore, MD 21208  |  PHONE: 800.329.0365  •  410.653.0194  |  FAX: 410.653.9969