New Account Application

Find Providers

Please enter your zip code so we can find facilities near you.
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If your provider is not shown and you feel you have received this message in error, please contact your provider directly for assistance.

Add Provider(s)


Instructions
Please select the name of the facility where you received services. Then, enter the account number you received from your facility.
How To Find Your Account Number
Your "Account number" can be found in the Account field in the description of charges section of your facility statement. Note, this is not the responsible party number. Refer to the link below for a sample of where to locate your provider "Account Number".
View Sample Statement
Provider Account Number
Note:

When requesting a new account for this provider, balances are required to meet or exceed $--.--

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