Provider OnLine Account Administrator Application

Understanding the Role of a Provider OnLine Account Administrator

A Provider OnLine Account Administrator has three important responsibilities:

  • Managing user access to Provider OnLine for one or more provider offices.
  • Ensuring the information accessed via Provider OnLine is only used for Legitimate business reasons.
  • Serving as the primary contact for provider office security issues.

A formal statement of all responsibilities will be provided to individuals who are initially approved as Provider OnLine Account Administrator. All responsibilities must be accepted before full Account Administrator access can be granted.

Primary Account Administrator Applicant

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Associated Practices

An Account Administrator may serve one or more practices. List all practices, (each having a unique tax ID number) that will be associated with the applicant listed above.


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Secondary Account Administrator Applicant

A secondary Account Administrator should be assigned to serve the above listed practices. Secondary Account Administrators have the same responsibilities and rights as as a primary Account Administrator and can act in the absence of the primary Account Administrator.

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