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Browser Second Factor

U.S. Bank Request for Information Form.

Yes! I would like more information on how U.S. Bank Healthcare Payment Management can help me increase collections at the point of service, reduce bad debt, and improve the patient experience. Please have a U.S. Bank representative contact me to set up an online product demonstration.

NAME

TITLE

PRACTICE

TELEPHONE

EMAIL ADDRESS

I prefer that you contact me by:
telephone
email

Do you currently accept these forms of payment? (check all that apply):
Credit Cards
Visa Cards
MasterCard
Discover
Checks

If yes, what is your average monthly credit card volume?

How many locations do you have?

At how many of them do you process payments?

Do you verify patient insurance eligibility?
Yes
No

How do you verify eligibility?(check all that apply)
Phone Web Other

Do you offer your patients payment plans (installment plans)?
Yes
No

Do you print and/or mail your own patient statements?
Yes
No

What practice management system do you use?

Who is your current clearinghouse?

What is your timeline for implementing HPM?
0-1 month
2-5 months
6+ months

FREE CMS ICD-10 Implementation Handbooks Click here to find out more.

Credentialing and Privileging Data Collection - videos. To view the training videos on Provider Attestation and Browser Second Factor Provisioning click here

WPA Field Mapping Guide NOW Available to assist in mapping your provider data to the new ProviderSource application. click here

Health Information Exchange Project Updated. Read the latest on the Washington State HIE: click here