Change Healthcare Provider Complete Enrollment & Deactivation - STI

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Change Healthcare Provider Complete Enrollment & Deactivation

Select one of the following options to begin:

Enroll a Practice or Provider
Deactivate a Provider
Enroll for Electronic Patient Statements *Note: The Electronic Patient Statement fee per page is $0.78 for the first page, additional pages are $0.15 and NCOA is $0.35 each.*

Enroll Practice or Provider
Deactivate Provider
Electronic Patient Statements

Enroll Practice or Provider

Are you a Billing Service?*
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

Deactivate Provider

Provider Complete - Deactivate a Provider

Billing Service (if applicable)
Contact Name*
First Last Suffix
Contact Phone*
Contact Email*
Practice Name*
Provider Name*
First Last Credentials
Provider Tax ID*
Provider NPI*
Do you wish to deactivate another provider?*
- Yes
- No
2nd Provider Name*
First Last Credentials
Provider Tax ID*
Provider NPI*
Do you wish to deactivate another provider?*
- Yes
- No
3rd Provider Name*
First Last Credentials
Provider Tax ID*
Provider NPI*
Do you wish to add another provider?*
- Yes
- No
4th Provider Name*
First Last Credentials
Provider Tax ID*
Provider NPI*
Do you wish to deactivate another provider?*
- Yes
- No
5th Provider Name*
First Last Credentials
Provider Tax ID*
Provider NPI*
CAPTCHA

Electronic Patient Statements

Electronic Patient Statements

Practice Name:*
Authorized Contact Name:*
First Last
Job Title:*
Email (You will receive confirmation by e-mail):*

About Us

For over 40 years, STI Computer Services has been your healthcare partner providing and pioneering the latest software, technology and support to thousands of ambulatory medical practices. Learn more about how we are advancing the delivery of ambulatory healthcare for clinicians with Service, Technology and Innovation.

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