If you are part of a registered group of Plan, please ask your group administrator to add you as a user instead registering as a new provider.

Users are responsible for providing true and adequate information during this registration process. They are also responsible for the administration of the Provider Account, once it is been created and approved, following the HIPAA guidelines, and according to the portal Terms of Use.

Health Plan information Guidelines

Please provide the name of the main provider or owner of the business as described in the previous section. The information is used to verify the identity of the user and business requesting access to the portal.

Health Plan Information

  • Health Plan Name *
  • Admin First Name
  • Admin Last Name
  • Admin Email

User Information

  • First Name *
  • MI
  • Last Name *
  • Email *
  • Confirm Email *
  • Job Title *
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2.1.0.0-R2D2[ez6.5.1]-4.5.30319.42000