New Enrollment Request
Enroll a group practice or solo provider in electronic clearinghouse services
Use this form to enroll a group practice or solo provider in electronic clearinghouse services with one or more government or commercial insurance payers.
Remember to send all signed copies of the payer agreements directly to the payer (and the clearinghouse if specified on the agreement cover page).
2. Practice or Group Information
e.g. 12-3456789 or 123-45-6789
A valid NPI has 10 digits
3. Select the Clearinghouse You Will Use