Thank you for your interest in our billing services.

All of your information is kept strictly confidential.

Name *
Name
Do you have a DBA, PLLC, or any other legal business name? If you do, please enter it below.
Phone *
Phone
Date of Birth *
Date of Birth
Your National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States. NUMBERS ONLY; NO DASHES.
This can also be your Social Security Number (SSN). NUMBERS ONLY; NO DASHES.
What's your social media presence?
http://
Please create a password for your Aurora Acupuncture Billing Client Portal Page
In insurance language, this translates into 1-unit of acupuncture (there is a 4-unit max). For example, if you charge $125 per 15-minute unit, a treatment could be billed out at $125, $250, $375, or $500 depending on treatment length.
W-9 forms need to be sent out to each insurance company that we bill for you so that you can receive a 1099 form from each insurance company billed for your taxes.
I am in-network with the following insurance companies: *
Service Location *
Service Location
This is where you provide treatment.
Billing Address
Billing Address
This is where your checks will be sent (leave blank if billing and service addresses are the same)