Registration For Registration Assistance, please call: 800-673-2465

New User Information
STEP 1 OF 2
WHAT YOU NEED TO REGISTER:

EOR information must be from a paid EOR. Information on Denied or Zero Pay EORs cannot be used for registration.
  • Bill ID - found on the EOR
  • Tax ID (TIN) - TIN of the Provider to whom the check was payable.
  • Claim or Reference Number - OR -
  • Claimant First Name
  • Claimant Last Name
  • Date of Birth
  • Date of Loss
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* Enter the Bill ID exactly as shown at the top, right, of your Explanation of Review form, including dashes. This is a unique identifier formatted something like GUA-GUPA-1234 or 44444-h-34567, etc.
* Enter the TIN (Tax ID) of the Provider to whom the check was payable.
* Please indicate if you have a Claim Number or Reference Number. You can use that information to register.
EOR Sample:
EOR Sample
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* - indicates required field