Request a Quote

Please complete the following request for information, and we will be in touch with you soon.

Client Name

Address

E-mail

Phone Number

Fax Number

Type of Business (i.e., Doctor, Hospital, Clinic, Other, etc) Please specify

Service location(s) provided

Special Request and/or Instructions

Account Information

At what age would you be outsourcing your accounts to us?

Approximately how many accounts do you expect to place initially?

Will your accounts include insurance balances from M/Caid, M/Care, Private Insurance, and self-pay?

Yes No

Will you be transmitting accounts monthly?

Yes No

Approximately how many accounts will you place with each transmission?

If you are currently using an agency, are you interested in pulling the accounts dated 2004-2009 that have not been collected on by your current agency and placing them with us?

Yes No

approximate number of accounts?

If so, would you like a separate one-time quote on these older accounts?

(Optional) What does your current agency charge in fee? (We would like to beat your current agencies fee when possible)

Do you use a billing service?

Yes No

Do you have internet access?

Yes No

How will you be transmitting your data? (We accept emailed files, paper copies mailed through the US Postal system, downloads to our FTP site, or you may enter them through Web-Host)

What format will your download be in? (Preferred formats are: ASCII fixed, comma delimited, and tab delimited text files, however, we can work with all types of data)

Can you comply with dates of service?

Yes No

On what date could we expect you to begin transmitting your data to us?

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Testimonials

Dear Burns & Carlisle:
This letter is being written to thank you for your professionalism and your hard work. Your Staff has always been courteous, friendly and professional. It has been a pleasure to work with an agency that you can trust and have full confidence in their ability.

We appreciate what you have done for us and the results you have produced.

I have and will continue to recommend any healthcare provider looking for a good, effective collection agency to try Burns & Carlisle.