www.changehealthcare.com
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151.101.67.10
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Submitted URL: http://changehealthcare.com/
Effective URL: https://www.changehealthcare.com/
Submission: On November 03 via manual from US — Scanned from DE
Effective URL: https://www.changehealthcare.com/
Submission: On November 03 via manual from US — Scanned from DE
Form analysis 4 forms found in the DOM
Name: ContactUs — POST https://tracking.changehealthcare.com/e/f2
<form method="post" name="ContactUs" action="https://tracking.changehealthcare.com/e/f2" onsubmit="return handleFormSubmit(this)" id="form419" class="elq-form" novalidate="novalidate">
<input value="ContactUs" type="hidden" name="elqFormName">
<input value="1647363395" type="hidden" name="elqSiteId">
<input name="elqCampaignId" type="hidden">
<span id="action_insert_16589433837748615" class="at-element-marker" style="top: -15px !important; position: relative !important;"><span style="color:#001f3f;">Interested in learning more about how our solutions can help? Fill out the form below
and an expert will reach out shortly to discuss your needs. If you're looking for product support, you can access your
</span><a href="https://support.changehealthcare.com/customer-support-portals" target="_self"><span style="color:#b10dc9;">support portal here</span></a><span style="color:#001f3f;">.</span></span>
<div id="formElement0" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size at-element-marker">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field0" class="label-position top ">First Name <span class="required">* </span>
</label>
<input id="field0" name="firstName" type="text" value="" class="field-size-top-medium" required="">
</p>
</div>
</div>
</div>
<div id="formElement1" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field1" class="label-position top ">Last Name <span class="required">* </span>
</label>
<input id="field1" name="lastName" type="text" value="" class="field-size-top-medium" required="">
</p>
</div>
</div>
</div>
<div id="formElement2" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size full-width">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field2" class="label-position top ">Business Email: <span class="required">* </span>
</label>
<input id="field2" name="emailAddress" type="email" value="" class="field-size-top-medium" required="">
</p>
</div>
</div>
</div>
<div id="formElement3" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field3" class="label-position top ">Job Function <span class="required">* </span>
</label>
<select id="field3" name="jobRole1" data-value="<eloqua type='emailfield' syntax='Job_Function1' />" class="field-size-top-medium" required="">
<option value="">-- Please Select -- </option>
<option value="Administrative/Human Resources">Administrative/Human Resources </option>
<option value="Administrator">Administrator </option>
<option value="Billing/Coding">Billing/Coding </option>
<option value="Board Member/Director/Trustee">Board Member/Director/Trustee </option>
<option value="Cardiology">Cardiology </option>
<option value="Care Management/Population Health">Care Management/Population Health </option>
<option value="Claims & Denials">Claims & Denials </option>
<option value="Consulting">Consulting </option>
<option value="Dentistry">Dentistry </option>
<option value="EDI">EDI </option>
<option value="EHR Implementation/Management">EHR Implementation/Management </option>
<option value="Engineering/Technical Staff">Engineering/Technical Staff </option>
<option value="Enrollment">Enrollment </option>
<option value="Executive">Executive </option>
<option value="Finance/Accounting">Finance/Accounting </option>
<option value="General Management">General Management </option>
<option value="Information Systems/Technology">Information Systems/Technology </option>
<option value="Laboratory">Laboratory </option>
<option value="Legal/Regulatory/Compliance">Legal/Regulatory/Compliance </option>
<option value="Medical Auditing">Medical Auditing </option>
<option value="Medical Practice Management">Medical Practice Management </option>
<option value="Member Engagement">Member Engagement </option>
<option value="Nurse/Nursing Executive">Nurse/Nursing Executive </option>
<option value="Office Manager">Office Manager </option>
<option value="Operations">Operations </option>
<option value="Patient Access">Patient Access </option>
<option value="Patient Financial Services">Patient Financial Services </option>
<option value="Pharmacy">Pharmacy </option>
<option value="Physician">Physician </option>
<option value="Physician Practice Management">Physician Practice Management </option>
<option value="Procurement/Purchasing/Supply">Procurement/Purchasing/Supply </option>
<option value="Project Management">Project Management </option>
<option value="Radiology">Radiology </option>
<option value="Revenue Cycle Management">Revenue Cycle Management </option>
<option value="Sales/Business Development/Marketing">Sales/Business Development/Marketing </option>
<option value="Training/Education">Training/Education </option>
<option value="Vendor Relationships">Vendor Relationships </option>
<option value="Other">Other </option>
</select>
</p>
</div>
</div>
</div>
<div id="formElement4" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field4" class="label-position top ">Job Level <span class="required">* </span>
</label>
<select id="field4" name="jobLevel1" data-value="<eloqua type='emailfield' syntax='Job_Lebel1' />" class="field-size-top-medium" required="">
<option value="">-- Please Select -- </option>
<option value="Analyst/Administrator">Analyst/Administrator </option>
<option value="Chief Compliance Officer">Chief Compliance Officer </option>
<option value="Chief Executive Officer">Chief Executive Officer </option>
<option value="Chief Financial Officer">Chief Financial Officer </option>
<option value="Chief Information Officer">Chief Information Officer </option>
<option value="Chief Medical Information Officer">Chief Medical Information Officer </option>
<option value="Chief Medical Officer">Chief Medical Officer </option>
<option value="Chief Operating Officer">Chief Operating Officer </option>
<option value="Chief Quality Officer">Chief Quality Officer </option>
<option value="Chief Technology Officer">Chief Technology Officer </option>
<option value="C-Level">C-Level </option>
<option value="Department Chair">Department Chair </option>
<option value="Director">Director </option>
<option value="Doctor">Doctor </option>
<option value="Individual Contributor">Individual Contributor </option>
<option value="Manager">Manager </option>
<option value="President">President </option>
<option value="Senior Vice President">Senior Vice President </option>
<option value="Vice President">Vice President </option>
<option value="Other">Other </option>
</select>
</p>
</div>
</div>
</div>
<div id="formElement5" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<!-- SOI update Feb11 START -->
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field5" class="label-position top ">Solution of Interest <span class="required">* </span>
</label>
<select id="field5" name="productSolutionOfInterest1" class="field-size-top-medium" required="">
<option value="" selected="selected">-- Please Select -- </option>
<option value="Decision Support">Clinical Decision Support Solutions </option>
<option value="Clinical Network">Clinical Interoperability Solutions </option>
<option value="Consumer Payments & Communications">Consumer Payments & Communications </option>
<option value="Dental EDI Network">Dental Network Solutions </option>
<option value="Imaging">Enterprise Imaging Solutions </option>
<option value="Consulting">Healthcare Consulting Services </option>
<option value="Data & Analytics">Healthcare Data & Analytics Solutions </option>
<option value="Medical Network">Medical Network Solutions </option>
<option value="Medical Record Retrieval & Clinical Review
">Medical Record Retrieval & Clinical Review </option>
<option value="Eligibility & Enrollment">Member Eligibility & Enrollment Solutions </option>
<option value="Member Engagement">Member Engagement Solutions </option>
<option value="Patient Access & Eligibility">Patient Access & Financial Clearance Solutions </option>
<option value="Engagement & Experience">Engagement & Experience </option>
<option value="Connected Consumer Health - Provider">Patient Experience Solutions </option>
<option value="Payment Accuracy">Payment Accuracy Solutions </option>
<option value="Pharmacy Benefit Solutions">Pharmacy Benefit Solutions </option>
<option value="Pharmacy Solutions">Pharmacy Solutions </option>
<option value="Provider Network Optimization">Provider Network Optimization Solutions </option>
<option value="Provider Payments">Provider Payment Management Solutions </option>
<option value="Revenue Improvement">Revenue Cycle Management Solutions </option>
<option value="Risk Adjustment Analytics">Risk Adjustment and Quality Solutions </option>
<option value="Transparency & Provider Search">Transparency & Provider Search </option>
<option value="Value-Based Care Enablement">Value-Based Care Enablement </option>
<option value="Value-Based Payments">Value-Based Care Solutions </option>
</select>
</p>
</div>
</div>
</div>
<!-- SOI update Feb11 END -->
<div id="formElement6" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" style="display: none;">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field6" class="label-position top ">Solution Type </label>
<select id="field6" name="solutionType1" class="field-size-top-medium">
<option value="">-- Please Select -- </option>
<option value="Services">Services </option>
<option value="Technology">Technology </option>
<option value="Unsure">Unsure </option>
</select>
</p>
</div>
</div>
</div>
<div id="formElement7" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" style="display: none;">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field7" class="label-position top ">Claims Volume </label>
<input id="field7" name="ClaimsVolume" type="text" value="" class="field-size-top-medium">
</p>
</div>
</div>
</div>
<div id="formElement8" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field8" class="label-position top ">Company <span class="required">* </span>
</label>
<input id="field8" name="company" type="text" value="" class="field-size-top-medium" required="">
</p>
</div>
</div>
</div>
<div id="formElement9" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field9" class="label-position top ">Company Type <span class="required">* </span>
</label>
<select id="field9" name="organizationType1" data-value="<eloqua type='emailfield' syntax='Company_Type1' />" class="field-size-top-medium" required="">
<option value="" selected="selected">-- Please Select -- </option>
<option value="Billing Service">Billing Service </option>
<option value="Dental">Dental </option>
<option value="Emergency Medical Service">Emergency Medical Service </option>
<option value="Government Agency">Government Agency </option>
<option value="Healthcare Information Exchange">Healthcare Information Exchange </option>
<option value="Home Health Agency">Home Health Agency </option>
<option value="Hospital Employed Practice">Hospital Employed Practice </option>
<option value="Hospital/Health System">Hospital/Health System </option>
<option value="Imaging Center">Imaging Center </option>
<option value="Independent Practice Affiliated with Hospital">Independent Practice Affiliated with Hospital </option>
<option value="Independent Practice Not Affiliated with Hospital">Independent Practice Not Affiliated with Hospital </option>
<option value="Laboratory">Laboratory </option>
<option value="Partner/Reseller">Partner/Reseller </option>
<option value="Payer">Payer </option>
<option value="Software Vendor">Software Vendor </option>
<option value="Trust">Trust </option>
<option value="Other">Other </option>
</select>
</p>
</div>
</div>
</div>
<div id="formElement10" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" style="display: none;">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field10" class="label-position top ">Bed Size </label>
<select id="field10" name="BedSize" class="field-size-top-medium">
<option value="" selected="selected">-- Please Select -- </option>
<option value="1-199">1-199 </option>
<option value="200+">200+ </option>
</select>
</p>
</div>
</div>
</div>
<div id="formElement11" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" style="display: none;">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field11" class="label-position top ">Practice Specialty </label>
<select id="field11" name="ProviderSpecialty" class="field-size-top-medium">
<option value="">-- Please Select -- </option>
<option value="Anesthesia">Anesthesia </option>
<option value="Cardiology">Cardiology </option>
<option value="Emergency Medicine">Emergency Medicine </option>
<option value="Pathology">Pathology </option>
<option value="Radiology">Radiology </option>
<option value="Other">Other </option>
</select>
</p>
</div>
</div>
</div>
<div id="formElement12" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" style="display: none;">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field12" class="label-position top ">Number of Covered Lives </label>
<input id="field12" name="NumCoveredLives" type="text" value="" class="field-size-top-medium">
</p>
</div>
</div>
</div>
<div id="formElement13" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size" style="display: none;">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field13" class="label-position top ">Practice Management Software Vendor </label>
<input id="field13" name="SoftwareVendor" type="text" value="" class="field-size-top-medium">
</p>
</div>
</div>
</div>
<div id="formElement14" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field14" class="label-position top ">Business Phone <span class="required">* </span>
</label>
<input id="field14" name="busPhone" type="text" value="" class="field-size-top-medium" required="">
</p>
</div>
</div>
</div>
<div id="formElement15" class="sc-view form-design-field sc-static-layout item-padding sc-regular-size">
<div class="field-wrapper">
</div>
<div class="individual field-wrapper">
<div class="_100 field-style">
<p class="field-p">
<label for="field15" class="label-position top ">Country <span class="required">* </span>
</label>
<select id="field15" name="Country" class="field-size-top-medium" required="">
<option value="">Please select </option>
<option value="US">United States </option>
<option value="GB">United Kingdom </option>
<option value="CA">Canada </option>
<option value="IN">India </option>
<option value="NL">Netherlands </option>
<option value="AU">Australia </option>
<option value="ZA">South Africa </option>
<option value="FR">France </option>
<option value="DE">Germany </option>
<option value="SG">Singapore </option>
<option value="SE">Sweden </option>
<option value="BR">Brazil </option>
<option value="">-------------- </option>
<option value="AF">Afghanistan </option>
<option value="AX">Åland Islands </option>
<option value="AL">Albania </option>
<option value="DZ">Algeria </option>
<option value="AS">American Samoa </option>
<option value="AD">Andorra </option>
<option value="AO">Angola </option>
<option value="AI">Anguilla </option>
<option value="AQ">Antarctica </option>
<option value="AG">Antigua and Barbuda </option>
<option value="AR">Argentina </option>
<option value="AM">Armenia </option>
<option value="AW">Aruba </option>
<option value="AU">Australia </option>
<option value="AT">Austria </option>
<option value="AZ">Azerbaijan </option>
<option value="BS">Bahamas </option>
<option value="BH">Bahrain </option>
<option value="BD">Bangladesh </option>
<option value="BB">Barbados </option>
<option value="BY">Belarus </option>
<option value="BE">Belgium </option>
<option value="BZ">Belize </option>
<option value="BJ">Benin </option>
<option value="BM">Bermuda </option>
<option value="BT">Bhutan </option>
<option value="BO">Bolivia </option>
<option value="BA">Bosnia and Herzegovina </option>
<option value="BW">Botswana </option>
<option value="BV">Bouvet Island </option>
<option value="BR">Brazil </option>
<option value="IO">Brit/Indian Ocean Terr. </option>
<option value="BN">Brunei Darussalam </option>
<option value="BG">Bulgaria </option>
<option value="BF">Burkina Faso </option>
<option value="BI">Burundi </option>
<option value="KH">Cambodia </option>
<option value="CM">Cameroon </option>
<option value="CA">Canada </option>
<option value="CV">Cape Verde </option>
<option value="KY">Cayman Islands </option>
<option value="CF">Central African Republic </option>
<option value="TD">Chad </option>
<option value="CL">Chile </option>
<option value="CN">China </option>
<option value="CX">Christmas Island </option>
<option value="CC">Cocos (Keeling) Islands </option>
<option value="CO">Colombia </option>
<option value="KM">Comoros </option>
<option value="CG">Congo </option>
<option value="CD">Congo, The Dem. Republic Of </option>
<option value="CK">Cook Islands </option>
<option value="CR">Costa Rica </option>
<option value="CI">Côte d'Ivoire </option>
<option value="HR">Croatia </option>
<option value="CU">Cuba </option>
<option value="CY">Cyprus </option>
<option value="CZ">Czech Republic </option>
<option value="DK">Denmark </option>
<option value="DJ">Djibouti </option>
<option value="DM">Dominica </option>
<option value="DO">Dominican Republic </option>
<option value="EC">Ecuador </option>
<option value="EG">Egypt </option>
<option value="SV">El Salvador </option>
<option value="GQ">Equatorial Guinea </option>
<option value="ER">Eritrea </option>
<option value="EE">Estonia </option>
<option value="ET">Ethiopia </option>
<option value="FK">Falkland Islands </option>
<option value="FO">Faroe Islands </option>
<option value="FJ">Fiji </option>
<option value="FI">Finland </option>
<option value="FR">France </option>
<option value="GF">French Guiana </option>
<option value="PF">French Polynesia </option>
<option value="TF">French Southern Terr. </option>
<option value="GA">Gabon </option>
<option value="GM">Gambia </option>
<option value="GE">Georgia </option>
<option value="DE">Germany </option>
<option value="GH">Ghana </option>
<option value="GI">Gibraltar </option>
<option value="GB">United Kingdom </option>
<option value="GR">Greece </option>
<option value="GL">Greenland </option>
<option value="GD">Grenada </option>
<option value="GP">Guadeloupe </option>
<option value="GU">Guam </option>
<option value="GT">Guatemala </option>
<option value="GN">Guinea </option>
<option value="GW">Guinea-Bissau </option>
<option value="GY">Guyana </option>
<option value="HT">Haiti </option>
<option value="HM">Heard/McDonald Isls. </option>
<option value="HN">Honduras </option>
<option value="HK">Hong Kong </option>
<option value="HU">Hungary </option>
<option value="IS">Iceland </option>
<option value="IN">India </option>
<option value="ID">Indonesia </option>
<option value="IR">Iran </option>
<option value="IQ">Iraq </option>
<option value="IE">Ireland </option>
<option value="IL">Israel </option>
<option value="IT">Italy </option>
<option value="JM">Jamaica </option>
<option value="JP">Japan </option>
<option value="JO">Jordan </option>
<option value="KZ">Kazakhstan </option>
<option value="KE">Kenya </option>
<option value="KI">Kiribati </option>
<option value="KP">Korea (North) </option>
<option value="KR">Korea (South) </option>
<option value="KW">Kuwait </option>
<option value="KG">Kyrgyzstan </option>
<option value="LA">Laos </option>
<option value="LV">Latvia </option>
<option value="LB">Lebanon </option>
<option value="LS">Lesotho </option>
<option value="LR">Liberia </option>
<option value="LY">Libya </option>
<option value="LI">Liechtenstein </option>
<option value="LT">Lithuania </option>
<option value="LU">Luxembourg </option>
<option value="MO">Macau </option>
<option value="MK">Macedonia </option>
<option value="MG">Madagascar </option>
<option value="MW">Malawi </option>
<option value="MY">Malaysia </option>
<option value="MV">Maldives </option>
<option value="ML">Mali </option>
<option value="MT">Malta </option>
<option value="MH">Marshall Islands </option>
<option value="MQ">Martinique </option>
<option value="MR">Mauritania </option>
<option value="MU">Mauritius </option>
<option value="YT">Mayotte </option>
<option value="MX">Mexico </option>
<option value="FM">Micronesia </option>
<option value="MD">Moldova </option>
<option value="MC">Monaco </option>
<option value="MN">Mongolia </option>
<option value="MS">Montserrat </option>
<option value="MA">Morocco </option>
<option value="MZ">Mozambique </option>
<option value="MM">Myanmar </option>
<option value="MP">N. Mariana Isls. </option>
<option value="NA">Namibia </option>
<option value="NR">Nauru </option>
<option value="NP">Nepal </option>
<option value="NL">Netherlands </option>
<option value="AN">Netherlands Antilles </option>
<option value="NC">New Caledonia </option>
<option value="NZ">New Zealand </option>
<option value="NI">Nicaragua </option>
<option value="NE">Niger </option>
<option value="NG">Nigeria </option>
<option value="NU">Niue </option>
<option value="NF">Norfolk Island </option>
<option value="NO">Norway </option>
<option value="OM">Oman </option>
<option value="PK">Pakistan </option>
<option value="PW">Palau </option>
<option value="PS">Palestinian Territory, Occupied </option>
<option value="PA">Panama </option>
<option value="PG">Papua New Guinea </option>
<option value="PY">Paraguay </option>
<option value="PE">Peru </option>
<option value="PH">Philippines </option>
<option value="PN">Pitcairn </option>
<option value="PL">Poland </option>
<option value="PT">Portugal </option>
<option value="PR">Puerto Rico </option>
<option value="QA">Qatar </option>
<option value="RE">Reunion </option>
<option value="RO">Romania </option>
<option value="RU">Russian Federation </option>
<option value="RW">Rwanda </option>
<option value="KN">Saint Kitts and Nevis </option>
<option value="LC">Saint Lucia </option>
<option value="WS">Samoa </option>
<option value="SM">San Marino </option>
<option value="ST">Sao Tome/Principe </option>
<option value="SA">Saudi Arabia </option>
<option value="SN">Senegal </option>
<option value="CS">Serbia and Montenegro </option>
<option value="SC">Seychelles </option>
<option value="SL">Sierra Leone </option>
<option value="SG">Singapore </option>
<option value="SK">Slovak Republic </option>
<option value="SI">Slovenia </option>
<option value="SB">Solomon Islands </option>
<option value="SO">Somalia </option>
<option value="ZA">South Africa </option>
<option value="ES">Spain </option>
<option value="LK">Sri Lanka </option>
<option value="SH">St. Helena </option>
<option value="PM">St. Pierre and Miquelon </option>
<option value="VC">St. Vincent and Grenadines </option>
<option value="SD">Sudan </option>
<option value="SR">Suriname </option>
<option value="SJ">Svalbard/Jan Mayen Isls. </option>
<option value="SZ">Swaziland </option>
<option value="SE">Sweden </option>
<option value="CH">Switzerland </option>
<option value="SY">Syria </option>
<option value="TW">Taiwan </option>
<option value="TJ">Tajikistan </option>
<option value="TZ">Tanzania </option>
<option value="TH">Thailand </option>
<option value="TL">Timor-Leste </option>
<option value="TG">Togo </option>
<option value="TK">Tokelau </option>
<option value="TO">Tonga </option>
<option value="TT">Trinidad and Tobago </option>
<option value="TN">Tunisia </option>
<option value="TR">Turkey </option>
<option value="TM">Turkmenistan </option>
<option value="TC">Turks/Caicos Isls. </option>
<option value="TV">Tuvalu </option>
<option value="UG">Uganda </option>
<option value="UA">Ukraine </option>
<option value="AE">United Arab Emirates </option>
<option value="US">United States </option>
<option value="UM">US Minor Outlying Is. </option>
<option value="UY">Uruguay </option>
<option value="UZ">Uzbekistan </option>
<option value="VU">Vanuatu </option>
<option value="VA">Vatican City </option>
<option value="VE">Venezuela </option>
<option value="VN">Viet Nam </option>
<option value="VG">Virgin Islands (British) </option>
<option value="VI">Virgin Islands (U.S.) </option>
<option value="WF">Wallis/Futuna Isls. </option>
<option value="EH">Western Sahara </option>
<option value="YE">Yemen </option>
<option value="ZM">Zambia </option>
<option value="ZW">Zimbabwe </option>
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<option value="AL">Alabama </option>
<option value="AR">Arkansas </option>
<option value="AS">American Samoa </option>
<option value="AZ">Arizona </option>
<option value="CA">California </option>
<option value="CO">Colorado </option>
<option value="CT">Connecticut </option>
<option value="DC">D.C. </option>
<option value="DE">Delaware </option>
<option value="FL">Florida </option>
<option value="FM">Micronesia </option>
<option value="GA">Georgia </option>
<option value="GU">Guam </option>
<option value="HI">Hawaii </option>
<option value="IA">Iowa </option>
<option value="ID">Idaho </option>
<option value="IL">Illinois </option>
<option value="IN">Indiana </option>
<option value="KS">Kansas </option>
<option value="KY">Kentucky </option>
<option value="LA">Louisiana </option>
<option value="MA">Massachusetts </option>
<option value="MD">Maryland </option>
<option value="ME">Maine </option>
<option value="MH">Marshall Islands </option>
<option value="MI">Michigan </option>
<option value="MN">Minnesota </option>
<option value="MO">Missouri </option>
<option value="MP">Marianas </option>
<option value="MS">Mississippi </option>
<option value="MT">Montana </option>
<option value="NC">North Carolina </option>
<option value="ND">North Dakota </option>
<option value="NE">Nebraska </option>
<option value="NH">New Hampshire </option>
<option value="NJ">New Jersey </option>
<option value="NM">New Mexico </option>
<option value="NV">Nevada </option>
<option value="NY">New York </option>
<option value="OH">Ohio </option>
<option value="OK">Oklahoma </option>
<option value="OR">Oregon </option>
<option value="PA">Pennsylvania </option>
<option value="PR">Puerto Rico </option>
<option value="PW">Palau </option>
<option value="RI">Rhode Island </option>
<option value="SC">South Carolina </option>
<option value="SD">South Dakota </option>
<option value="TN">Tennessee </option>
<option value="TX">Texas </option>
<option value="UT">Utah </option>
<option value="VA">Virginia </option>
<option value="VI">Virgin Islands </option>
<option value="VT">Vermont </option>
<option value="WA">Washington </option>
<option value="WI">Wisconsin </option>
<option value="WV">West Virginia </option>
<option value="WY">Wyoming </option>
<option value="">-- Other Locations -- </option>
<option value="AA">Military Americas </option>
<option value="AE">Military Europe/ME/Canada </option>
<option value="AP">Military Pacific </option>
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<option value="NS">Nova Scotia </option>
<option value="NT">Northwest Territories </option>
<option value="NU">Nunavut </option>
<option value="ON">Ontario </option>
<option value="PE">Prince Edward Island </option>
<option value="QC">Quebec </option>
<option value="SK">Saskatchewan </option>
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<option value="">-------------- </option>
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<option value="BO">Bolivia </option>
<option value="BA">Bosnia and Herzegovina </option>
<option value="BW">Botswana </option>
<option value="BV">Bouvet Island </option>
<option value="BR">Brazil </option>
<option value="IO">Brit/Indian Ocean Terr. </option>
<option value="BN">Brunei Darussalam </option>
<option value="BG">Bulgaria </option>
<option value="BF">Burkina Faso </option>
<option value="BI">Burundi </option>
<option value="KH">Cambodia </option>
<option value="CM">Cameroon </option>
<option value="CA">Canada </option>
<option value="CV">Cape Verde </option>
<option value="KY">Cayman Islands </option>
<option value="CF">Central African Republic </option>
<option value="TD">Chad </option>
<option value="CL">Chile </option>
<option value="CN">China </option>
<option value="CX">Christmas Island </option>
<option value="CC">Cocos (Keeling) Islands </option>
<option value="CO">Colombia </option>
<option value="KM">Comoros </option>
<option value="CG">Congo </option>
<option value="CD">Congo, The Dem. Republic Of </option>
<option value="CK">Cook Islands </option>
<option value="CR">Costa Rica </option>
<option value="CI">Côte d'Ivoire </option>
<option value="HR">Croatia </option>
<option value="CU">Cuba </option>
<option value="CY">Cyprus </option>
<option value="CZ">Czech Republic </option>
<option value="DK">Denmark </option>
<option value="DJ">Djibouti </option>
<option value="DM">Dominica </option>
<option value="DO">Dominican Republic </option>
<option value="EC">Ecuador </option>
<option value="EG">Egypt </option>
<option value="SV">El Salvador </option>
<option value="GQ">Equatorial Guinea </option>
<option value="ER">Eritrea </option>
<option value="EE">Estonia </option>
<option value="ET">Ethiopia </option>
<option value="FK">Falkland Islands </option>
<option value="FO">Faroe Islands </option>
<option value="FJ">Fiji </option>
<option value="FI">Finland </option>
<option value="FR">France </option>
<option value="GF">French Guiana </option>
<option value="PF">French Polynesia </option>
<option value="TF">French Southern Terr. </option>
<option value="GA">Gabon </option>
<option value="GM">Gambia </option>
<option value="GE">Georgia </option>
<option value="DE">Germany </option>
<option value="GH">Ghana </option>
<option value="GI">Gibraltar </option>
<option value="GB">United Kingdom </option>
<option value="GR">Greece </option>
<option value="GL">Greenland </option>
<option value="GD">Grenada </option>
<option value="GP">Guadeloupe </option>
<option value="GU">Guam </option>
<option value="GT">Guatemala </option>
<option value="GN">Guinea </option>
<option value="GW">Guinea-Bissau </option>
<option value="GY">Guyana </option>
<option value="HT">Haiti </option>
<option value="HM">Heard/McDonald Isls. </option>
<option value="HN">Honduras </option>
<option value="HK">Hong Kong </option>
<option value="HU">Hungary </option>
<option value="IS">Iceland </option>
<option value="IN">India </option>
<option value="ID">Indonesia </option>
<option value="IR">Iran </option>
<option value="IQ">Iraq </option>
<option value="IE">Ireland </option>
<option value="IL">Israel </option>
<option value="IT">Italy </option>
<option value="JM">Jamaica </option>
<option value="JP">Japan </option>
<option value="JO">Jordan </option>
<option value="KZ">Kazakhstan </option>
<option value="KE">Kenya </option>
<option value="KI">Kiribati </option>
<option value="KP">Korea (North) </option>
<option value="KR">Korea (South) </option>
<option value="KW">Kuwait </option>
<option value="KG">Kyrgyzstan </option>
<option value="LA">Laos </option>
<option value="LV">Latvia </option>
<option value="LB">Lebanon </option>
<option value="LS">Lesotho </option>
<option value="LR">Liberia </option>
<option value="LY">Libya </option>
<option value="LI">Liechtenstein </option>
<option value="LT">Lithuania </option>
<option value="LU">Luxembourg </option>
<option value="MO">Macau </option>
<option value="MK">Macedonia </option>
<option value="MG">Madagascar </option>
<option value="MW">Malawi </option>
<option value="MY">Malaysia </option>
<option value="MV">Maldives </option>
<option value="ML">Mali </option>
<option value="MT">Malta </option>
<option value="MH">Marshall Islands </option>
<option value="MQ">Martinique </option>
<option value="MR">Mauritania </option>
<option value="MU">Mauritius </option>
<option value="YT">Mayotte </option>
<option value="MX">Mexico </option>
<option value="FM">Micronesia </option>
<option value="MD">Moldova </option>
<option value="MC">Monaco </option>
<option value="MN">Mongolia </option>
<option value="MS">Montserrat </option>
<option value="MA">Morocco </option>
<option value="MZ">Mozambique </option>
<option value="MM">Myanmar </option>
<option value="MP">N. Mariana Isls. </option>
<option value="NA">Namibia </option>
<option value="NR">Nauru </option>
<option value="NP">Nepal </option>
<option value="NL">Netherlands </option>
<option value="AN">Netherlands Antilles </option>
<option value="NC">New Caledonia </option>
<option value="NZ">New Zealand </option>
<option value="NI">Nicaragua </option>
<option value="NE">Niger </option>
<option value="NG">Nigeria </option>
<option value="NU">Niue </option>
<option value="NF">Norfolk Island </option>
<option value="NO">Norway </option>
<option value="OM">Oman </option>
<option value="PK">Pakistan </option>
<option value="PW">Palau </option>
<option value="PS">Palestinian Territory, Occupied </option>
<option value="PA">Panama </option>
<option value="PG">Papua New Guinea </option>
<option value="PY">Paraguay </option>
<option value="PE">Peru </option>
<option value="PH">Philippines </option>
<option value="PN">Pitcairn </option>
<option value="PL">Poland </option>
<option value="PT">Portugal </option>
<option value="PR">Puerto Rico </option>
<option value="QA">Qatar </option>
<option value="RE">Reunion </option>
<option value="RO">Romania </option>
<option value="RU">Russian Federation </option>
<option value="RW">Rwanda </option>
<option value="KN">Saint Kitts and Nevis </option>
<option value="LC">Saint Lucia </option>
<option value="WS">Samoa </option>
<option value="SM">San Marino </option>
<option value="ST">Sao Tome/Principe </option>
<option value="SA">Saudi Arabia </option>
<option value="SN">Senegal </option>
<option value="CS">Serbia and Montenegro </option>
<option value="SC">Seychelles </option>
<option value="SL">Sierra Leone </option>
<option value="SG">Singapore </option>
<option value="SK">Slovak Republic </option>
<option value="SI">Slovenia </option>
<option value="SB">Solomon Islands </option>
<option value="SO">Somalia </option>
<option value="ZA">South Africa </option>
<option value="ES">Spain </option>
<option value="LK">Sri Lanka </option>
<option value="SH">St. Helena </option>
<option value="PM">St. Pierre and Miquelon </option>
<option value="VC">St. Vincent and Grenadines </option>
<option value="SD">Sudan </option>
<option value="SR">Suriname </option>
<option value="SJ">Svalbard/Jan Mayen Isls. </option>
<option value="SZ">Swaziland </option>
<option value="SE">Sweden </option>
<option value="CH">Switzerland </option>
<option value="SY">Syria </option>
<option value="TW">Taiwan </option>
<option value="TJ">Tajikistan </option>
<option value="TZ">Tanzania </option>
<option value="TH">Thailand </option>
<option value="TL">Timor-Leste </option>
<option value="TG">Togo </option>
<option value="TK">Tokelau </option>
<option value="TO">Tonga </option>
<option value="TT">Trinidad and Tobago </option>
<option value="TN">Tunisia </option>
<option value="TR">Turkey </option>
<option value="TM">Turkmenistan </option>
<option value="TC">Turks/Caicos Isls. </option>
<option value="TV">Tuvalu </option>
<option value="UG">Uganda </option>
<option value="UA">Ukraine </option>
<option value="AE">United Arab Emirates </option>
<option value="US">United States </option>
<option value="UM">US Minor Outlying Is. </option>
<option value="UY">Uruguay </option>
<option value="UZ">Uzbekistan </option>
<option value="VU">Vanuatu </option>
<option value="VA">Vatican City </option>
<option value="VE">Venezuela </option>
<option value="VN">Viet Nam </option>
<option value="VG">Virgin Islands (British) </option>
<option value="VI">Virgin Islands (U.S.) </option>
<option value="WF">Wallis/Futuna Isls. </option>
<option value="EH">Western Sahara </option>
<option value="YE">Yemen </option>
<option value="ZM">Zambia </option>
<option value="ZW">Zimbabwe </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement6" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45577">State or Province <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45577" name="stateProv" style="width:100%;" data-value="~~eloqua..type--emailfield..syntax--State_Prov~~" required="">
<option value="">Please Select... </option>
<option value="AK">Alaska </option>
<option value="AL">Alabama </option>
<option value="AR">Arkansas </option>
<option value="AS">American Samoa </option>
<option value="AZ">Arizona </option>
<option value="CA">California </option>
<option value="CO">Colorado </option>
<option value="CT">Connecticut </option>
<option value="DC">D.C. </option>
<option value="DE">Delaware </option>
<option value="FL">Florida </option>
<option value="FM">Micronesia </option>
<option value="GA">Georgia </option>
<option value="GU">Guam </option>
<option value="HI">Hawaii </option>
<option value="IA">Iowa </option>
<option value="ID">Idaho </option>
<option value="IL">Illinois </option>
<option value="IN">Indiana </option>
<option value="KS">Kansas </option>
<option value="KY">Kentucky </option>
<option value="LA">Louisiana </option>
<option value="MA">Massachusetts </option>
<option value="MD">Maryland </option>
<option value="ME">Maine </option>
<option value="MH">Marshall Islands </option>
<option value="MI">Michigan </option>
<option value="MN">Minnesota </option>
<option value="MO">Missouri </option>
<option value="MP">Marianas </option>
<option value="MS">Mississippi </option>
<option value="MT">Montana </option>
<option value="NC">North Carolina </option>
<option value="ND">North Dakota </option>
<option value="NE">Nebraska </option>
<option value="NH">New Hampshire </option>
<option value="NJ">New Jersey </option>
<option value="NM">New Mexico </option>
<option value="NV">Nevada </option>
<option value="NY">New York </option>
<option value="OH">Ohio </option>
<option value="OK">Oklahoma </option>
<option value="OR">Oregon </option>
<option value="PA">Pennsylvania </option>
<option value="PR">Puerto Rico </option>
<option value="PW">Palau </option>
<option value="RI">Rhode Island </option>
<option value="SC">South Carolina </option>
<option value="SD">South Dakota </option>
<option value="TN">Tennessee </option>
<option value="TX">Texas </option>
<option value="UT">Utah </option>
<option value="VA">Virginia </option>
<option value="VI">Virgin Islands </option>
<option value="VT">Vermont </option>
<option value="WA">Washington </option>
<option value="WI">Wisconsin </option>
<option value="WV">West Virginia </option>
<option value="WY">Wyoming </option>
<option value="">-- Other Locations -- </option>
<option value="AA">Military Americas </option>
<option value="AE">Military Europe/ME/Canada </option>
<option value="AP">Military Pacific </option>
<option value="AB">Alberta </option>
<option value="MB">Manitoba </option>
<option value="BC">British Columbia </option>
<option value="NB">New Brunswick </option>
<option value="NL">Newfoundland and Labrador </option>
<option value="NS">Nova Scotia </option>
<option value="NT">Northwest Territories </option>
<option value="NU">Nunavut </option>
<option value="ON">Ontario </option>
<option value="PE">Prince Edward Island </option>
<option value="QC">Quebec </option>
<option value="SK">Saskatchewan </option>
<option value="YT">Yukon Territory </option>
<option value="Other">Other </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement7" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45578">Address 1 <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="address1" id="fe45578" value="" style="width:100%;" required="">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement8" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45579">Company Website </label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<input type="text" class="elq-item-input" name="website" id="fe45579" value="" style="width:100%;">
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement9" class="elq-field-style form-element-layout row">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45580">Company Profile <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45580" name="companyProfile" style="width:100%;" data-value="" required="">
<option value="">Select </option>
<option value="Public">Public </option>
<option value="Partnership">Partnership </option>
<option value="Incorporated">Incorporated </option>
<option value="Start Up">Start Up </option>
<option value="Association">Association </option>
<option value="Other">Other </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement10" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45581">What best describes what you would like to learn more about? </label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45581" name="learnMore" style="width:100%;" data-value="">
<option value="">Select </option>
<option value="The overall Change Healthcare solution portfolio">The overall Change Healthcare solution portfolio </option>
<option value="A specific solution area">A specific solution area </option>
<option value="Partnership programs at Change Healthcare">Partnership programs at Change Healthcare </option>
<option value="How to become a Partner">How to become a Partner </option>
<option value="Other">Other </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement11" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45582">What type of products or services does your company provide? </label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45582" name="productsServices" style="width:100%;" data-value="">
<option value="">Select </option>
<option value="Clinical Solutions">Clinical Solutions </option>
<option value="Rev Cycle Solutions">Rev Cycle Solutions </option>
<option value="Ambulatory Solutions (non-acute)">Ambulatory Solutions (non-acute) </option>
<option value="Connectivity/Integration Solutions">Connectivity/Integration Solutions </option>
<option value="Data Solutions">Data Solutions </option>
<option value="Services (Managed, Implementation, Consulting, Education, Hosting, etc)">Services (Managed, Implementation, Consulting, Education, Hosting, etc) </option>
<option value="Technical">Technical </option>
<option value="EMR/EHR">EMR/EHR </option>
<option value="Digital Health">Digital Health </option>
<option value="Platform">Platform </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement12" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45583">Type of partnership interest? <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45583" name="typePartnership" style="width:100%;" data-value="" required="">
<option value="">Select </option>
<option value="API marketplace">API marketplace </option>
<option value="Channel">Channel </option>
<option value="Data subscription">Data subscription </option>
<option value="Technology">Technology </option>
<option value="Vendor">Vendor </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement13" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45584">How would you describe the opportunity for partnership between our two organizations? </label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<textarea class="elq-item-textarea" style="width:100%;" name="partnershipOppt" id="fe45584"> </textarea>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement14" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45585">Who are the targeted end users? <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45585" name="targetUsers" style="width:100%;" data-value="" required="">
<option value="">Select </option>
<option value="Hospitals/health systems">Hospitals/health systems </option>
<option value="Dental">Dental </option>
<option value="Physicians">Physicians </option>
<option value="Nurses">Nurses </option>
<option value="Physician practices">Physician practices </option>
<option value="Exec">Exec </option>
<option value="Technical">Technical </option>
<option value="Administrative">Administrative </option>
<option value="Payers">Payers </option>
<option value="Labs">Labs </option>
<option value="Other">Other </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement15" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45586">Area of interest for this partnership? </label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45586" name="areaInterest" style="width:100%;" data-value="">
<option value="">Select </option>
<option value="Clinical Orders/Results">Clinical Orders/Results </option>
<option value="Clinical Decision Support">Clinical Decision Support </option>
<option value="Consumer Payments">Consumer Payments </option>
<option value="Coverage Insight">Coverage Insight </option>
<option value="Data and Analytics ">Data and Analytics </option>
<option value="EDI (Claims, Remits, Eligibility, etc)">EDI (Claims, Remits, Eligibility, etc) </option>
<option value="Electronic Chart Collaboration">Electronic Chart Collaboration </option>
<option value="Electronic ePrescribing">Electronic ePrescribing </option>
<option value="Electronic Prior Authorizations">Electronic Prior Authorizations </option>
<option value="Fraud, Waste and Abuse">Fraud, Waste and Abuse </option>
<option value="Population Health">Population Health </option>
<option value="Print Capabilities">Print Capabilities </option>
<option value="Revenue Cycle Management">Revenue Cycle Management </option>
<option value="Quality Solutions">Quality Solutions </option>
<option value="Payment Integrity Solutions">Payment Integrity Solutions </option>
<option value="Engagement Solutions">Engagement Solutions </option>
<option value="Payment Solutions">Payment Solutions </option>
<option value="Risk Adjustment Solutions">Risk Adjustment Solutions </option>
<option value="Network Solutions">Network Solutions </option>
<option value="Consulting">Consulting </option>
<option value="Write in/Other">Write in/Other </option>
<option value="APIs">APIs </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
<div class="grid-layout-col">
<div class="layout-col col-sm-12 col-xs-12">
<div id="formElement16" class="elq-field-style form-element-layout row full-width">
<div style="text-align:left;" class="col-sm-12 col-xs-12">
<label class="elq-label " for="fe45587">Do you have other business relationships with Change Healthcare? <span class="elq-required">* </span>
</label>
</div>
<div class="col-sm-12 col-xs-12">
<div class="row">
<div class="col-xs-12">
<div class="field-control-wrapper">
<select class="elq-item-select" id="fe45587" name="existingRelationship" style="width:100%;" data-value="" required="">
<option value="">Select </option>
<option value="Yes">Yes </option>
<option value="No">No </option>
</select>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row full-width">
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Our advanced technology solutions and services help payers achieve their
priorities across the member journey.
WHO WE HELP
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PARTNERS
Our advanced technology solutions empower our partners to achieve their
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PATIENTS
Our solutions streamline the engagement, care, and payment experience to improve
the patient journey.
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PROVIDERS
Our advanced technology and services help providers enhance patient
engagement and access, improve outcomes, drive revenue performance, and
improve operational efficiency.
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* 02/04
PAYERS
Our advanced technology solutions and services help payers achieve their
priorities across the member journey.
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* 03/04
PARTNERS
Our advanced technology solutions empower our partners to achieve their
strategic business objectives and meet their customers’ needs.
See how
* 04/04
PATIENTS
Our solutions streamline the engagement, care, and payment experience to
improve the patient journey.
See how
A TRUSTED PARTNERFOR ORGANIZATIONS COMMITTED TO IMPROVING THE HEALTHCARE SYSTEM
THROUGH TECHNOLOGY
15 billion
Healthcare transactions completed annually
1 in 3
U.S. patient records touched by our clinical connectivity solutions
OUR OUTCOMES
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INFOGRAPHIC
STREAMLINING PRIOR AUTHORIZATION
Learn more about how streamlining prior authorization can improve efficiency,
reduce costs, and keep you ahead of regulatory action.
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WHITE PAPER
TEN WAYS TO PROTECT YOUR HOSPITAL FROM RISING RISKS OF SELF-PAY
Discover how reexamining patient engagement technologies and revenue cycle
management can streamline the patient experience.
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ON-DEMAND WEBINAR
INTERQUAL CONNECT MEDICAL REVIEW SERVICE BY CHANGE HEALTHCARE
Learn how Review Share helps reduce the need for manual authorization
transactions by enabling cloud-hosted medical reviews between providers and
payers.
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WE'RE IMPROVING CLINICAL, FINANCIAL, AND CARE OUTCOMES SO THAT EVERYONE IN THE
HEALTHCARE SYSTEM CAN THRIVE.
* CLINICAL DECISION SUPPORT SOLUTIONS
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Careers
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