Support Query - MedicalRCS

Section 1 - Practitioner Details

Name of Practitioner *

Practice Number [BHF] *

Your Practice Number

Type of Query *

Claims Management [Billing, Reconciliation, Remittance]

Technical Support [Guidance on using Products and Services]

Systems and Integration [Software Functionality related]

Training [Request for Training]

If Claims Management has been selected, please provide: • Patient Name / ID Number • File Number • Date of Service Input N/A if not applicable

Subject or Topic *

Is this related to an existing Query? *

Yes

No

Enter a Query reference number *

Full description of new Query OR query follow‑up *

Product Identity Query is emanating from *

Healthness Web

Healthness Doctor

Healthness Patient

Other

Service Identity Query is emanating from *

Claims Management [Billing, Reconciliation, Remittance]

Credit Control and Collections [Debt Control]

Administration [Finance, Invoices, Registration]

Training

Other

Level of Urgency *

Low

Medium

Important

Urgent