Please enter the fields below to request access to our provider portal (to view bill review results), our eRFA site (to submit electronic RFAs), or both. Technical support questions should be directed to support@managewaresolutions.com

Facility or Group Name:
Provider First Name: *
Provider Last Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
NPI: *
Access:
Tax ID 1: *
Tax ID 2:
Tax ID 3:
Tax ID 4:
Contact Name: *
Contact Phone: *
Contact Email: *
Comment:
Upload W9: *