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Sections

Provider Account Request

Complete the fields below, then make a note of the username and password you choose. You'll need them to log in to your account once we activate it. Click any symbol for help.

Your Privacy is Important. Priority Health has a strict Privacy Policy. We will not share your account information with others.

* Indicates required information

User Information
First Name
Last Name
Your roles - check all that apply
Physician/Provider
Mid-level Provider
Nurse
Manager/Supervisor
Administrator
Billing
Referrals
Admissions
Authorizations
Quality/Incentives Coordinator
Patient Care/Safety
Discharge Planning
Administrative Assistant
Reception/Front Desk
Billing service/TPA
Email Address
Phone
( ) - ext.
Fax
( ) -
Username
(6-32 characters)
Password
(8+ characters, at least 1 number, case-sensitive)
Password Confirmation
Tools for Providers
Select all the tools that you would like associated with your account. Click any tool name to read a description.
Authorizations - Inquiry
Claims Inquiry
Filemart
Member Inquiry
Patient Profile
Rx History (PCP Only)

Provider Office Information
Group/Facility Name
as it appears on Remittance Advice
Group/Facility Tax ID Number
Vendor Number
as it appears on Remittance Advice
Address Line 1
as it appears on Remittance Advice
Address Line 2
City
State
Zip Code
Office Contact/Manager
Feedback
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