Medical fundings submission requirements

Obtaining a Pre-Qualification Analysis

1. Print out and complete the Provider Questionnaire (click here for a printable copy).

2. Fax or mail a completed and signed copy of the Questionnaire, including the Certification page, to us (fax number and address are on the form).

We will review your submission and determine the best way to proceed -- usually within 48 hours.

Preparing to Finalize Qualification for Funding

We will need the following documents from you to finalize your qualification request.

1. Your current Year-to-Date Profit/Loss Statement (Income Statement)

2. Your Prior Year Profit/Loss Statement (Income Statement)

3. Your current Year-to-Date Corporate Balance Sheet

4. Your Prior Year Corporate Balance Sheet

5. Your current Year-to-Date Accounts Receivable Aging Report (in 30-day increments)

Six Steps to Our Medical Receivables Funding Program

Step 1: Application Process. You must complete an Application including last year and interim financials and an accounts receivable report by payer.

Step 2: Application Review. Our Network will review your application, run a credit report and establish your "Estimated Net Receivable," based on the provided information.

Step 3: Letter of Intent. A Letter of Intent is issued confirming our Network's interest in buying the current accounts receivable from 0 to 90 days aging, the estimated amount of the first funding and the discount rate we will charge.

Step 4: Due Diligence Letter. Once the Letter of Intent is signed, a due diligence letter and Purchase Agreement are forwarded to you. This letter contains a list of items to be returned for review by the Network's Underwriting Department.

Step 5: On-Site Due Diligence: An on-site due diligence is scheduled to review documents provided and confirm/establish the actual Estimated Net Receivable and funding amount.

Step 6: Account is Funded. You are funded electronically for the first batch of claims 0 to 90 days old. Subsequent fundings are done electronically either weekly or bi-weekly depending on volume.

Our Receivables Funding Network has clear, concise underwriting criteria with minimum qualification time. Download, complete and submit your Provider Questionnaire today for a FREE analysis.