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5225 Canyon Crest
Suite #355
Riverside, CA 92507 |
Phone: 1-888-458-2033
Fax: 951-222-0212
Email: info@datagenix.com |
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| Please complete the form below An * indicates a required field. |
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| Products you are interested in: |
ClaimScape Medical Benefits Administration
Software
ClaimScape Claims Scanning System
ClaimScape Integrated Web-based Portal
ClaimScape Healthcare Payor Software |
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| Type of Organization: | |
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If Other, please
describe your organization: | |
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| Company Name:* | |
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| Company Website: | |
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| First Name:* | |
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| Last Name:* | |
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| Email Address:* | |
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| Phone Number:* | |
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| Position: |
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| Street Address: | |
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| Address Line 2: |
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| City: |
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| State/Province: |
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| Postal Code/Zip: |
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| Country: |
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How Many Claims
Does Your
Organization
Process per Month? |
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| and/or |
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How Many Lives Does
Your Organization
Cover? |
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| Timeline for purchase? | |
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Planned
implementation date? | |
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Planned system
go-live date? | |
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Are there any specific
reasons that you are
looking for a new
system? | |
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How did you find the
ClaimScape web site? | |
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If web search, what
search engine &
keyword?
If ad, what
publication? If other,
please elaborate. | |
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