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In order to be able to use this feature, Please complete your account type association at the bottom of the page. You can click on Go Back if you want to do this at a later time. * Required Field
Please review the information before you submit this registration. An Email will be sent to your registered email address to set your password.
Web Portal Preference
Please select the Portal that is listed in your provider training material. This selection determines the primary portal that you will using to submit cases over the web.
  • Default Portal*:
User Information
All Pre-Authorization notifications will be sent to the fax number and email address provided below. Please make sure you provide valid information.
User Found with Same FirstName, LastName and Email
  • User Name*:
     
    Email*:
     
    Confirm Email*:
     
    First Name*:
     
    Last Name*:
     
  • Address*:
    City*:
     
    State*:
    Zip*:
     
    Office Name*:
  • Phone*:
     
    Ext:
     
    Fax*:
User Registration
  • UserName:
    Email:
    Account Type:
    First Name:
    Last Name:
  • Address:
    City:
    State:
    Zip:
    Office Name:
  • Phone:
    Ext:
    Fax:
Provider Information
Payer Information
  • Facility Name: Billing Office Name:
  • Physician FirstName:
  • Physician LastName:
  • Street Address:
  • Zip Code:
  • State:
  • Tax ID:
  • NPI:
  • Health Plan Name
Provider Information
Account Type:*
Please Select the Physician that you represent. A notification will be sent to the organization regarding this registration
  • Physician First Name:
     
    Tax ID*:
     
  • Physician Last Name*:
     
    NPI:
     
Physician will be notified of your user registration
No Physician Search Results Were Found.
Select provider in the grid

Please read below to sign up as an appropriate user.

Physician: An Individual Practitioner, A Medical Group Practice or an assistant of a Physician who would create and check status of a Pre-authorization.

Facility: Diagnostic Imaging Center, In-Office Provider (IOP), Hospital or Facility who would create and check status of a Pre-Authorization.

Billing Office: A billing Office who can check the status of Pre-Authorization, claims and payments. If you represent multiple Tax IDs, please register with your Primary Tax ID. You can tie additional preferred Tax Ids after your initial login.

Health Plan: A Health Plan representative who can check the status of Pre-Authorization and Claims.