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Open New Service Case

Do you have questions?

or download our

(pdf).

No Surprises Act

Use the form below to create a case. You may open a negotiation, initiate IDR or ask a surprise bill question.

Network Links

Request to join the networks?

Request to terminate your participation?

Submit an application for recredentialing?

Update your demographic information?

Verify benefits, eligibility or claim payment status?

Obtain our Client List or Provider Handbook?

Important Message

When opening a Federal Surprise Bill negotiation, you must use the latest Open Negotiation Notice (form OMB Control No. 1210-0136 from dol.gov) and upload it to your service case.

For all other inquiries proceed below to open a customer service case.

*Select Entity Type

Select Entity Type

Rendering Health Facility, Practitioner or Group Practice (Licensed health care providers that render services to patients or an authorized representative thereof)

Third Party (Entity not affiliated with the above. (Examples: a law office or collection agency))