Provider Portal Registration

Request provider portal access

Use this form to request portal accounts for the staff at your practice. It replaces the paper registration packet.

This form does not create accounts. Every request is reviewed by the CHS MSO Portal Support Team, who set up the accounts once the request is approved.

Already have an account? If you are unable to sign in, please request help with an existing account instead of using this form.

Do you also need access to the DHMSO Portal?

The DHMSO Portal is registered for on its own form, which a different helpdesk processes; this request does not cover it. If it applies to your practice, please complete that form as well.

Complete the DHMSO Portal form online Download the blank PDF instead Visit the DHMSO Portal

Who is submitting this request?

I am one of the users requesting access. You will be listed among the portal users below. I am submitting this request on behalf of the requested user(s). For example, an office manager or a billing company.

How should portal email be delivered?

Portal notifications and password resets are sent by email. Please select the option that matches your office.

A separate email for each user Enter each person's email beside their name below. One shared office email All portal mail goes to a single monitored mailbox.

Who needs a portal account?

Please list one person per line, up to 20. The preview on the right shows exactly how we read what you typed.

Portal users * Accepted formats: Name, Name <email>, Name - email, Name : email.

How your entries will be read

0 users

Practice information

Group / organization name *

Tax ID (EIN, nine digits) *

Practice address *

Practice phone *

Fax *

What should these users be able to see?

Access to all providers at this practice Limit access to specific providers List the providers below.

Authorization

* I certify that I am authorized to request portal access for this practice, and that the information provided above is accurate and complete.

Saved draft

Your answers are saved in this browser as you type.

Need help? Email or call .

Finish these items to submit: