Registration

This registration is for the person at your organization who is responsible for managing all web site (portal) users within your organization. This person is typically a manager. If you are not the person that will manage all the users for your organization, PLEASE DO NOT fill this out. Please have your Office Administrator (OA) for this web site complete this registration form.

If you are a billing company that is not owned by the practice, you will need to have the Office Administrator (OA) at the practice complete this registration form.

Please provide the following information so we can accurately process your registration:

CreateUserViewModel

Provider Representative Territory Responsibilities

*All fields are required

(If you do not have a Blue Cross group number, provide the physicians Blue KC 8 digit Legacy provider number in this field)

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