Payor Registration

Please Note: This registration form is for Payors only. If you are a PreferredOne Administrative Services, PreferredoneInsurance Company or PreferredOne Community Health Plan member and wish to register, Click Here.

Welcome to PreferredOne's secured payor administrative web site. As a first time user of your site, we'll need to know some basic clinic information from you in order to set up the appropriate security for your transactions. Please complete the form below. When finished, click the submit button. The information will be transmitted to our provider services area for setup. Once setup is complete, your will be notified of the user name and password required to access the services this process can take one to two business days to complete.

Contact:

Alternate Contact:

Phone Number:

Alt. Phone Number:

Email Address:

Alt. Email Address:

Payor Name:

Payor Address:

Payor City:

Payor State:

Payor Zip:

Primary Users: