YAKC Medical Group Inc.

Healthcare Consulting Services Request

Please complete this form so we can better understand your practice's needs. Once submitted, a consultant will review your request and contact you within 1–2 business days to discuss your goals, provide recommendations, and prepare a customized service proposal.

Provider Information

Practice Name*

Provider Name*

Credentials (MD, DO, NP, PA, etc.)

Specialty

Tax ID (Optional)

NPI Number (Optional)

Practice Address

Contact Information

Primary Contact Person*

Title

Phone Number*

Email Address*

Preferred Method of Contact

PhoneEmailVirtual Meeting

Which Service(s) Are You Interested In?

Check all that apply.

Prior Authorization Services

Prior Authorization SubmissionAuthorization Follow-UpReferral CoordinationMedical Necessity Review

Tell Us About Your Needs

What challenges is your practice currently experiencing?

Practice Information

Approximately how many patient encounters does your practice see each month?

Less than 100100–500500–1,0001,000+

Current Systems

Electronic Medical Record (EMR)

Practice Management Software

Billing Software

Encoder (if applicable)

Specialty Information

Please select your specialty.

Desired Service Start Date

Additional Information

Please tell us anything else that will help us understand your goals.

Consultation Request

Would you like to schedule a FREE consultation?

YesNo

Agreement

By submitting this form, I certify that the information provided is accurate to the best of my knowledge. I understand that submitting this request does not establish a contractual agreement. A representative from YAKC Medical Group Inc. will contact me to discuss my request and provide a customized proposal for services.

Printed Name*

I agree to the terms stated above and certify the information provided is accurate.

Healthcare Consulting Services Request

Provider Information

Contact Information

Which Service(s) Are You Interested In?

Medical Coding Services

Medical Billing Services

Coding Audits