Client Tools

• Health Portal Enrollment Form (Provider)   – Register a provider for multiple services at once. Includes enrolling for E-Prescribing, Direct Messaging, EPCS , ePA Enrollment, PatientPortal and/or Provider Complete.
• Health Portal Deactivation Form (Provider)
• Lab/Interfaces Enrollment
• Practice Level Direct Address – Request Form
• Prescription Drug Monitoring Program (PDMP) Enrollment
• Prescription Drug Monitoring Program (PDMP) Deactivation

For Providers:

For FIRST-TIME enrollments, adding a NEW PROVIDER to an existing enrollment, DEACTIVATION of an existing provider and ELECTRONIC PATIENT STATEMENTS:

Change Healthcare Provider Complete Enrollment & Deactivation

For Billing Services:

For FIRST-TIME enrollments, adding a NEW PROVIDER to an existing enrollment, DEACTIVATION of an existing provider and ELECTRONIC PATIENT STATEMENTS:

• BILLING SERVICES: Change Healthcare Provider Complete Enrollment & Deactivation