Electronic enrollment just got easier. The Electronic Provider Profile replaces all our previous registration forms, contracts and addendums. And original signatures have been eliminated. For questions call (800) 924-7141 and speak "Enrollment".
To enroll in electronic claims filing, to add a provider to an existing electronic practice or make any changes in your electronic filing process you must complete an Electronic Provider Profile Form.
If you are a new Billing Agent, Clearinghouse or Vendor you must complete an Electronic Vendor Profile Form. Also if you are making any changes or migrating to the new EC Gateway Bulletin Board System a profile is also required.
If you would like to make changes to your current electronic mailbox(s), or add additional Users to access your mailbox(s), you must complete to a Secure File Gateway (SFG) Request For Access Form.
In order to protect your secure access to our systems, each individual who will be accessing our systems is required to submit the Provider Account Security Form.