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**STAGING ENVIRONMENT**
Provider Registration
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Fields marked with '*' are required.
Passwords must be at least 8 characters long and contain 4 following:
One capital letter
One lowercase letter
One number (0-9)
One special character ($, %, &, etc.)
Email
*
Password
*
Confirm password
*
First Name
*
Last Name
*
TIN
*
Registration Number
*
The Registration number is found at the bottom of an EOB.
Terms of Service
By checking the box below, I agree and acknowledge:
1)
to maintain the confidentiality of all information provided via PHP TPA Services website in compliance with all applicable laws and PHP TPA Services policies;
2)
to not allow any other person to learn or use my password;
3)
to notify PHP TPA Services in the event I have reason to believe somebody has my password or has attempted to access the PHP TPA Services website in my name;
4)
to not attempt to alter any information on the website;
5)
to notify PHP TPA Services within 24 hours of my separation from the provider identified above;
6)
that PHP TPA Services reserves the right to limit, suspend or terminate my access to the website; and
7)
that my employer and I will hold PHP TPA Services harmless in the event I breach any of the above terms.
I Agree to the Terms of Service