Register Here
(If you received a secure email notification, please use the link in the email to begin the registration process or enter the authorization code from the email below.)
IMPORTANT—PLEASE READ BEFORE SUBMITTING THE REGISTRATION FORM
Only fill out this form if you are registering to be a Local Administrator for your organization. Please contact your existing Local Administrator for the following self-service options:
If you do not know your existing Local Administrator, please contact Provider Inquiry for assistance at 1-888-732-7364.
NOTE: If you are registering more than one Local Administrator, you must provide a unique email address for each on the form.
If you have received an email to register, you can use the link in the email to begin the registration process or enter the authorization code from the email below.
For more information. please see our Provider Portal User Registration Guide (PDF)