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Health services provider

Request to add a practitioner to an existing account for online direct billing

Please submit the following practitioner information to us. Once the practitioner has been linked with your clinic, you’ll receive a confirmation email and you can then add them as a practitioner during time of claim entry. If you have any additional questions, please contact us directly at 1-800-588-1195.

Please enter the provider name.

Please enter an association name

Please enter the practice name.

Please enter an address.

Please enter a valid phone number.

Please enter a valid login ID number.

Please enter a valid email address.