Use this form to request an account to enter claims online. It is separate from your Office Manager account (if you have one). If you already have a login with us you will need to choose a different User ID for this account. You cannot choose a User ID that is already taken. Please take note of your User ID and password as you'll need to remember them later.

NOTE: We are planning on going live with the system in late October so you may not receive a response until then.

Required fields are denoted by a red asterisk (*).

Online Claims Submission Sign-up

    
* User ID:  
* Password: Must contain at least 1 number, 1 lowercase letter, and 1 uppercase letter. At least 5 characters long.
* Tax ID: 9 characters long, no dashes.
* Last Name:
* First Name:
* Company:
Contact:
* Address:
 
* City,State,Zip:
* Work Phone: No Dashes.
* E-Mail:
Fax: No Dashes.
 
* Associated Providers
   


NPINameRemove

    



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© Copyright 2005, Children's Mercy Family Health Partners. All Rights Reserved. System availability, transaction execution and response times may vary due to volume, system performance and/or other factors.