• Please enter all field to begin the enrollment process.
  • Your email address will be your user name.
  • A user admin must verify your account before your account is provisioned
User Information
Associated Providers
Provider Information

Use the following steps to add provider(s) for whom you will request a prior authorization (PA):

  1. Begin typing the provider’s name or license number in the Associated Providers field.
  2. When the drop down list displays, select the provider’s name you wish to add, and then click Add. The selected provider is displayed on the right side of this window.
  3. If you will request PAs for multiple providers, repeat steps 1 and 2 until all providers have been selected.

Note: If you mistakenly added a provider, click Remove to remove the provider from the list of selected providers.

Associated Providers
No Associated Providers