Sign up to BETA test the new RevAssurance Online today!

Thank you for expressing your interest in the brand new RevAssurance platform!

Please fill out the form below and our team will reach out to you to register you and your four (4) additional RevAssurance Online BETA test users.

NOTE: Your BETA test account will expire June 15, 2020. After your test period has concluded, you will be offered a 50% OFF discount on launch day for any feedback, comments, and testimonials you provide.

Thank you!

    * = required

    *Email

    *Full Name

    Phone

    Company

    Your Position

    Full Address (Street, City, State, Postal Code)

    *If you are an existing customer, please let us know which RevAssurance product you have purchased in the past:

    If you selected "other" above, please list other products here, comma-separated.

    Which jurisdictions are most relevant to you and your revenue cycle needs?

    If you selected "other" above, please list other jurisdictions here, comma-separated.

    Your BETA access to RevAssurance will also grant you temporary access to our helpdesk. When your BETA period has concluded, would you be interested in upgrading your helpdesk experience to RevAssurance Support?

    Click HERE to learn more about each tier of support.

    Additional Users

    1. Email: Full Name:
    2. Email: Full Name:
    3. Email: Full Name:
    4. Email: Full Name:

    NOTE: Please note that the submission forms on this site are not protected by security mechanisms. Therefore, please refrain from including sensitive information and the unsecured transfer of PHI which could constitute a HIPAA violation.

    By submitting this form and signing up to become a BETA tester, you agree to present evaluations, including any comments, concerns, suggestions, or testimonials from yourself and your additional users prior to or upon expiration of your testing period.

    Before you click "Send", please check each box below to agree to each of the following: