info.clearbalance.org
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Submitted URL: https://t.sidekickopen01.com/Ctc/GC+23284/cwMwK04/JkM2-6q7W6N1vHY6lZ3pHW2nqmY83zWg5CW3R11X93dc838W67lG7f4ncZSlW7nxc-K1n313qW6...
Effective URL: https://info.clearbalance.org/making-a-difference-2023
Submission: On April 28 via manual from US — Scanned from DE
Effective URL: https://info.clearbalance.org/making-a-difference-2023
Submission: On April 28 via manual from US — Scanned from DE
Form analysis 2 forms found in the DOM
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<div class="input"><input id="firstname-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" name="firstname" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="given-name" value=""></div>
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<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="lastname-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" name="lastname" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="family-name" value=""></div>
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<div class="hs_company hs-company hs-fieldtype-text field hs-form-field"><label id="label-company-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" class="" placeholder="Enter your Company name"
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<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="company-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" name="company" placeholder="" type="text" class="hs-input" inputmode="text" autocomplete="organization" value=""></div>
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<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><input id="email-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" name="email" required="" placeholder="" type="email" class="hs-input" inputmode="email" autocomplete="email" value=""></div>
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</fieldset>
<fieldset class="form-columns-1">
<div class="hs_patients_must_complete_an_application_form_to_participate_in_the_clearbalance_program_ hs-patients_must_complete_an_application_form_to_participate_in_the_clearbalance_program_ hs-fieldtype-select field hs-form-field"><label
id="label-patients_must_complete_an_application_form_to_participate_in_the_clearbalance_program_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" class=""
placeholder="Enter your Patients must complete an application form to participate in the ClearBalance program."
for="patients_must_complete_an_application_form_to_participate_in_the_clearbalance_program_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028"><span>Patients must complete an application form to participate in the ClearBalance program.</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
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name="patients_must_complete_an_application_form_to_participate_in_the_clearbalance_program_">
<option disabled="" value="">Please Select</option>
<option value="True">True</option>
<option value="False">False</option>
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</fieldset>
<fieldset class="form-columns-1">
<div class="hs_how_does_the_patient_accept_the_clearbalance_credit_offer_ hs-how_does_the_patient_accept_the_clearbalance_credit_offer_ hs-fieldtype-select field hs-form-field"><label
id="label-how_does_the_patient_accept_the_clearbalance_credit_offer_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" class="" placeholder="Enter your How does the patient accept the ClearBalance credit offer?"
for="how_does_the_patient_accept_the_clearbalance_credit_offer_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028"><span>How does the patient accept the ClearBalance credit offer?</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><select id="how_does_the_patient_accept_the_clearbalance_credit_offer_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" class="hs-input is-placeholder" name="how_does_the_patient_accept_the_clearbalance_credit_offer_">
<option disabled="" value="">Please Select</option>
<option value="By filling out an application for the program.">By filling out an application for the program.</option>
<option value="By making the first payment to ClearBalance.">By making the first payment to ClearBalance.</option>
<option value="When they call ClearBalance and say they want to be in it.">When they call ClearBalance and say they want to be in it.</option>
</select></div>
</div>
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<div class="hs_patients_can_manage_their_accounts_online_ hs-patients_can_manage_their_accounts_online_ hs-fieldtype-select field hs-form-field"><label
id="label-patients_can_manage_their_accounts_online_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" class="" placeholder="Enter your How can patients can manage their accounts online?"
for="patients_can_manage_their_accounts_online_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028"><span>How can patients can manage their accounts online?</span><span class="hs-form-required">*</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><select id="patients_can_manage_their_accounts_online_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" required="" class="hs-input is-placeholder" name="patients_can_manage_their_accounts_online_">
<option disabled="" value="">Please Select</option>
<option value="Calling the Patient Experience Center to have to account created for them">Call the Patient Experience Center to have to account created for them</option>
<option value="Creating an account for themselves at myclearbalance.com">Create an account for themselves at myclearbalance.com</option>
<option value="Online accounts are not available for ClearBalance">Online accounts are not available for the ClearBalance program</option>
</select></div>
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</fieldset>
<fieldset class="form-columns-1">
<div class="hs_if_you_suspect_identity_theft__you_should_just_call_the_patient_and_let_them_know_ hs-if_you_suspect_identity_theft__you_should_just_call_the_patient_and_let_them_know_ hs-fieldtype-select field hs-form-field"><label
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for="if_you_suspect_identity_theft__you_should_just_call_the_patient_and_let_them_know_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028"><span>If you suspect identity theft, you should:</span><span class="hs-form-required">*</span></label>
<legend class="hs-field-desc" style="display: none;"></legend>
<div class="input"><select id="if_you_suspect_identity_theft__you_should_just_call_the_patient_and_let_them_know_-57e96f69-29b1-419b-b826-9e279d5efbc8_7028" required="" class="hs-input is-placeholder"
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<option disabled="" value="">Please Select</option>
<option value="Report it to ClearBalance immediately">Report it to ClearBalance HealthCare immediately</option>
<option value="Report it to your supervisor/compliance/security officer">Report it to your supervisor/compliance/security officer</option>
<option value="Both A and B">Both A and B</option>
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<fieldset class="form-columns-1">
<div class="hs_you_can_add_balances_from_multiple_family_members_into_one_clearbalance_account_ hs-you_can_add_balances_from_multiple_family_members_into_one_clearbalance_account_ hs-fieldtype-select field hs-form-field"><label
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<legend class="hs-field-desc" style="display: none;"></legend>
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name="you_can_add_balances_from_multiple_family_members_into_one_clearbalance_account_">
<option disabled="" value="">Please Select</option>
<option value="True">True</option>
<option value="False">False</option>
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<div class="hs_submit hs-submit">
<div class="hs-field-desc" style="display: none;"></div>
<div class="actions"><input type="submit" class="hs-button primary large" value="Submit"></div>
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* Solutions * Awards & Certifications * Resources * News * About * Contact ENTER TO WIN A UV PHONE SANITIZER WITH WIRELESS CHARGING PAD AND TEST YOUR KNOWLEDGE OF THE CLEARBALANCE PROGRAM WITH THIS POP QUIZ! First name Last name Company name Email* Patients must complete an application form to participate in the ClearBalance program. Please SelectTrueFalse How does the patient accept the ClearBalance credit offer? Please SelectBy filling out an application for the program.By making the first payment to ClearBalance.When they call ClearBalance and say they want to be in it. How can patients can manage their accounts online?* Please SelectCall the Patient Experience Center to have to account created for themCreate an account for themselves at myclearbalance.comOnline accounts are not available for the ClearBalance program If you suspect identity theft, you should:* Please SelectReport it to ClearBalance HealthCare immediatelyReport it to your supervisor/compliance/security officerBoth A and B Patients may combine Provider balances of family members into one ClearBalance account/billing statement.* Please SelectTrueFalse NO PURCHASE NECESSARY TO ENTER OR WIN. VOID WHERE PROHIBITED BY LAW. THE SWEEPSTAKES BEGINS MONDAY, APRIL 24, 2023, AND ENDS FRIDAY, MAY 26, 2023, AT 12 P.M. EASTERN TIME. ELIGIBILITY: THE SWEEPSTAKES IS OPEN TO LEGAL RESIDENTS OF THE UNITED STATES, AGE 18 AND OVER WHO WORK IN HEALTHCARE REVENUE CYCLE, RECEIVED OUR E-MAIL BETWEEN APRIL 21, 2023 - APRIL 28, 2023 AND COMPLETED THE 5-QUESTION QUIZ. A PERFECT SCORE ON THE QUIZ IS NOT REQUIRED. VALID ENTRIES ARE THOSE SUBMITTED ONLINE USING THE OFFICIAL WEB ENTRY FORM INCLUDED IN THE E-MAIL. LIMIT ONE ENTRY PER PERSON. CLEARBALANCE HEALTHCARE EMPLOYEES AND THEIR FAMILIES ARE NOT ELIGIBLE. ON WEDNESDAY, MAY 31, 2023, EIGHT WINNERS WILL BE SELECTED AT RANDOM FROM THE POOL OF SUBMITTED ENTRY FORMS. THE ODDS OF WINNING ARE ESTIMATED TO BE 5 IN 1,396. PRIZE VALUE: THE ESTIMATED RETAIL VALUE OF THE UV PHONE SANITIZER WITH WIRELESS CHARGIN PAD IS $32.58 AS OF MARCH 27, 2023. SPONSOR: CLEARBALANCE HEALTHCARE IS LOCATED AT 3636 NOBEL DRIVE, SUITE 250, SAN DIEGO, CALIFORNIA. ← → * 1 * 2 * 3 * 4 * 5 * 6 * 7 * 8 * 9 SHARE YOUR STORY...WE'D LOVE TO SHARE WHAT YOU HEAR FROM PATIENTS! First Name* Last Name* Organization* Share your story: ClearBalance HealthCare enables healthcare providers to offer healthcare consumers an affordable, convenient way to pay their medical costs. * Solutions * Awards & Certifications * Resources * About * Contact © 2023 ClearBalance HealthCare Privacy Policy Terms of Service