Use this form to request changes in access for your organization.
Changes for individual users are made by your Point of Care Administrator.
Examples of changes:
- Add or Remove Tax IDs
- Add or remove Point of Care Administrators
- Add create/update access for authorization features
- Add or remove a designated agent
If you'd like to see the information that may be required, please
Print a List of Information Required.
Before you begin, please ensure that you have your organization
unit code and name and a legally authorized representative
of the company to electronically sign this request.
To avoid delays in processing or the
need to complete another form, please ensure that all information
is entered accurately prior to submitting.
Complete ONLY the sections that are applicable for your desired
changes. You'll be contacted
with your access information within 3-5 business days.
If you have any questions about this request, please contact us at: