Directions for Submitting a Request for Billing Records
To request a copy of a patient's billing records, please submit the following:
- A written request in letter format.
- A HIPAA-compliant authorization signed by the patient.
- A check in the amount of $15.00 for clerical/copying fees.
If your company does not have its own HIPAA-compliant authorization form, you may use our authorization form,
Please print the authorization form, fill it out completely, and have it signed by the patient.
The request, authorization, and check must be made out to MedAmerica Billing Services, Inc. (or MBSI) and mailed to:
MedAmerica Billing Services, Inc.
1601 Cummins Drive, Suite D
Modesto, CA 95358
Attn: Release of Information Dept.
If you have further Release of Information questions, please call (209) 567-5755.