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 REGISTRATION
This service allows access to specific policy benefits and claim status information for Medicare Supplement policies only.
 
Provider Details
Please complete the following provider specific information:
* Required Field
Provider Name*:
Facility Name:
Provider Street Address*:
City*:
State*:
Zip Code*:
User Details
Please complete the following personal information:
* Required Field
User First Name*:
Middle Initial:
Last Name*:
Telephone No*: - -
Email Address*:
Confirm Email*:
Choose UserName*:
Choose Password*:

Confirm Password*:
National Provider Identification number (NPI)
Please enter up to five national provider identification numbers (NPIs) to be associated with your username/password. You will be able to update and add additional NPIs after logging into your account. At least one NPI or TIN must be entered in order to proceed.
NPI Number 1: (e.g 0123456789) no dashes or no spaces
NPI Number 2:
NPI Number 3:
NPI Number 4:
NPI Number 5:
Tax ID Association
Please enter up to five tax identification numbers (TIN's) to be associated with your username and password combination. You will be able to update and add more TIN's after logging into your account. At least one NPI or TIN must be entered in order to proceed.
Tax ID Number 1: (e.g 123456789) no dashes or no spaces
Tax ID Number 2:
Tax ID Number 3:
Tax ID Number 4:
Tax ID Number 5: