Medical Billing Audit Form Practice / Clinic Name * Specialty Behavioral HealthPsychiatryPrimary CareInternal MedicineUrgent CareOther Number of Providers 1–23–56–1010+ Contact Person Name Email Address * Phone Number * Monthly Claim Volume <500500–1,5001,500–5,0005,000+ Current Billing Status New practiceIn-house billingOutsourced billingOther Comment
