Claim Rejection Support for Office Therapy

Please complete the following form to expedite your support request related to claims rejections
and Office Therapy Claims Manager for Office Therapy 10 ONLY.

ISSUES REPORTED USING THIS FORM, OTHER THAN CLAIM REJECTIONS AND CLAIM MANAGER
WILL NOT BE PROCESSED. Use the following form to report any other issues.
http://www.quicdoc.com/support_form.htm

Before submitting this form, you can search our Knowledgebase to see if your issue has a solution.

Customer Name:

Customer Phone:

Customer EMail:

Contact Person:

Electronic Claim Type: 50104010   

Clearinghouse Name:    Contact Information (Name and Phone):

If using Gateway EDI for Clearinghouse, please specify your Site ID:

Payor (for which rejections are occurring):

Rejection Details (reason, loop information, etc.)