Healthcare Billing360 Billing Forms

Below you'll find a list of each medical billing form you'll need to fill out. See an overview of each form and how it applies to your home healthcare business. The “Access Form” buttons will take you to the form.

Provider Details

This is a simple form that will provide Healthcare Billing360 with all the relevant details about your business as a healthcare professional. 

New Client Intake

This is a form that is filled out by either you on behalf of a client, or directly by your clients themselves. It provides Healthcare Billing360 with all the necessary details we need to submit claims for insurance purposes. 

Agency/Practice Information

This provides us with your various agency/practice fees based on relevant CPT Codes. You'll also provide credentials and details for any billing software you may currently be using. 

Patient Services Information

For each client visit you record, simply fill out our medical billing form and hit submit. For multiple entries, refresh the page and submit for each, individual visit. 

Provider Additions Corrections and Notes 

Use this form in lieu of e-mailing changes or corrections that contain Patient Health Information ( PHI) that needs to remain HIPAA compliant.