Register for an Account

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Tell us about you

*What is your email? (used for logon)

*Confirm your email?

*What is your first name?

*What is your last name?

*What is your phone #?

* What type of entity are you?

Rendering Health Facility, Practitioner or Group Practice

(Licensed healthcare providers that render services to patients or an authorized representative thereof.)

Third Party

(Entity not affiliated with the above. Examples: third party billing company or other outside agency, law office, collection agency, or an audit firm hired by the provider to capture additional revenue.)