Registration

February 4, 2012

* denotes a required field

Step 1: Choose a User Name and Password

Username:	Username must be at least 6 characters. Example: john44
Password:	Password must be 8 or more characters and contain characters from three of the following four categories: English upper case characters (A-Z) English lower case characters (a-z) Base 10 digits (0-9) Non-alphanumeric characters (!,$,#,%)
Confirm Password:

Step 2: Required Information

First Name:
Last Name:
Company:
Phone:	Ext:
Email Address:
Confirm Email:
Group Number:

Step 3: Request Access

Please select at least one of the following options to request access.

Claim Status Inquiry
Benefits & Eligibility Inquiry
View & Print Billing Invoices
Claims Detail Information - Full
Claims Detail Information - HIPAA
Group Docs
Online Enrollment
Eligibility List

Employer Registration