1161 58th SW, Wyoming, MI 49509
(616)532-8000 :: 1(800)968-6866

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Contract Projection Request
By supplying the information below IDS can provide you with a revenue projection tailored to your contract. This projection can be a useful tool in setting benchmarks as to your current or future performance of a contract. Your projection will indicate average charges per patient and average patient collections.

Please provide the following contact information:

Name*
Date
Organization*
Work Phone*
FAX
E-mail*
Facility name
Facility state
Annual Visits
Billable Visits
Avg. Charge

* indicates required field.

Please provide the following financial class information:

Avg. Charge		% of Visits
Blue Cross
Medicare
Medicaid
Commercial
Self Pay
Worker's Comp
Campus
Managed Care

Note: The results of this projection do not guarantee contract performance.

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