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Welcome to ConnectiCare's Provider Online Services. Your direct connection to the information you need.
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= Required fields
Provider TIN:
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9-digit tax identification number
First Name:
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Last Name:
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Contact Role:
Choose a role
Office Manager
Physician
Front End Staff
Billing Manager/Staff
Other
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Address:
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If the address you are looking for is not found, please manually enter your address and contact information. A Provider Education and Service Representative will be contacting you to update our system accordingly.
Provider Group Name:
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Office Email:
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You must provide your email address (e.g. provider@anywhere.com) for EFT payment notifications and other important notices.
Phone:
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Extension:
Fax:
User Name:
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You must create a user name that consists of any combination of letters and numbers with no spaces. User names must be at least 6 characters.
Password:
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You must create a strong password that contains at least one of the following: lower case letter, one upper case letter, one symbol and one number with no spaces. Passwords must be at least 8 characters long.
Confirm Password:
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Hint Question 1:
Choose a question
What is your best friend's mother's first name?
What was the last name of your favorite teacher?
What is your father's middle name?
Who is your favorite cartoon character?
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Hint Answer 2:
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Hint Question 2:
Choose a question
Which street did you grow up on?
What was the make of your first car?
What was your high school mascot?
What is your favorite restaurant?
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Hint Answer 2:
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= Required fields
