Enrollments

Provider Enrollment for Health Portal (eRx, EPCS, DM, ePA, Labs, etc) and more

Provider Enrollment Form for Health Portal  - Register a provider for multiple services at once. Includes enrolling for E-Prescribing, Direct Messaging, EPCS , ePA Enrollment, PatientPortal and/or Provider Complete.

Provider Deactivation Form

E-Prescribing/SureScripts Deactivation

Lab Interface Enrollment

Provider Complete and Electronic Patient Statements

Use the following forms if you are enrolling for the Provider Complete Program:

FOR THE FIRST TIME ENROLLMENT: Change Healthcare (Emdeon) Provider Complete Enrollment 

Add NEW PROVIDER To An Existing Enrollment: Provider Complete Enrollment

Deactivate an Existing Provider: Provider Complete - Deactivate a Provider


Use the following forms if you are a BILLING SERVICE COMPANY ONLY:

BILLING SERVICES COMPANIES ONLY: FOR THE FIRST TIME ENROLLMENT: Change Healthcare (Emdeon) Provider Complete

BILLING SERVICES COMPANIES ONLY: Add NEW PROVIDER To An Existing Enrolled Practice Change Healthcare Provider Complete Enrollment

Deactivate an Existing Provider: Provider Complete - Deactivate a Provider


Use the following form to enroll in Electronic Patient Statements:

Electronic Patient Statements

Mobile App Beta Release
More Enrollments (Order Supplies, Add/Disable Cloud Users)

Check the types of e-mail notifications you want sent to this address: