Medical Bill Review Services, Inc
3200 West End Ave. Suite 500
Nashville, TN 37203
866-615-1400
615-783-1707
Fax: 615-646-6856

For Employer Groups

Type of coverage?:	Fully self-employed Partially self-employed
Who currently Processes your claims?:
What timeframe for claims review?:	Current year Current year and 1 year preceding year Last two calendar years
Paid amount for Major Medical for review period?:
Estimate number of employees for review period?:
Primary concerns:
First Name:
Last Name:
Company:
Title:
Address:
City:
State:
Zipcode:
Phone #:
Fax #:
Email Address:
Web Address:
How did you find out about us?:	Search Engine Advertisement Personal Referral Other
Additional Comments:
*Authentication:
*1 + 8 =	Enter the correct answer to the math question.
Please click the Send button only once.