Please enter information in the following fields and an iHCFA Representative will contact you shortly.


 

  
 
Bill Submission Entities
This service will allow a User the ability to submit Workers Compensation HCFA & C-4 Bills on-line. Users who desire to register with iHCFA will be charged on a per bill basis which will depend upon the monthly volume and their billing system.

If you are a medical provider or represent a medical provider and are interested in learning more about this service please fill-out the form below and you will be contacted by a representative of our Company.

 
 

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* Corporate Name:

 
* Last Name:

 
* First Name:

 
* Phone:
Fax:
* Email Address:  
* Type of Practice:  
Address 1:  
Address 2:

 
* City:

 
* County:

 
* State and Zip:

 
* Physician Specialty WCB Classification:  
* No. of Providers:  
* No. of NYSIF Bills:    per month
* No. of WC Bills:    per month
* No. of Auto Bills:    per month
* Medical Billing Software:     Version:
EDI Version:    
Current Electronic Clearinghouse:    
Message: