ProviderConnect - Providers

Provider Online Services Registration

*Required fields are denoted by an asterisk ( ) adjacent to the label.

First Name

Last Name

Contact Name

Provider ID

Tax ID

Provider Group, Facility or Clinic Name (if applicable)

Primary Email Address

Verify Primary Email Address

Secondary Email Address

Phone Number

(10 digit number without dashes)
Ext

Fax Number

(10 digit number without dashes)

Password must be between 8 and 20 characters long, must contain at least one number (0-9), one upper case letter (A-Z), one lower case letter (a-z), one of these special characters ( ! # $ ~ " % & ' * + , - . : ; = ? [ ] ^ _ ` < > | { } \), but no spaces. Make sure it is difficult for others to guess. Your Password is case-sensitive.

Select a Password

Confirm New Password

Create a Security Question

Answer to Security Question

Please check the provider services you want access to:
Inquiry Functions	Claims Submission
Claims, Authorizations, Patient Eligibility, and Benefits searches will be available automatically upon acceptance of online registration.

For assistance with any technical problems (such as connecting to or accessing the site) please call our e-Support Help Line at 888-247-9311 during business hours Monday through Friday 8AM - 6PM ET or you can email an Applications Support Specialist at e-supportservices@carelon.com