CLIENT PROFILE FORM

(for Denial Research Group / AppealMasters)

  • YOUR FACILITY INFORMATION

  • SERVICES

  • LEAD CONTACT

  • BILLING INFORMATION

    Contact for Statements, A/R
  • SYSTEM USERS (Non-Veracity Clients only)

    System Users are facility personnel that need access to Veracity for purposes of entering case information, uploading documents, or checking case status.
  • DOCUMENT / RECORDS MANAGER

    The document manager is the default in Veracity for missing documents or record requests.
  • APPEAL INFORMATION

  • APPEAL TYPE

  • Denial / Audit Types
  • Issues
  • APPEAL VOLUME

  • Estimated number of cases to assign (monthly)
  • RECORDS AND DOCUMENTS

  • HANDLING YOUR APPEALS

  • Facility to Vendor Notification Process
  • To ensure timely submissions, AppealMasters will:
  • ALJ APPEALS

  • Facility Representative to be present for Hearing
  • Thank you for completing our information form. We look forward to working with you! Please submit by clicking the button below.