Priority Health - Employer Account Request

Complete the fields below, then make a note of the username and password you choose. You'll need them to log in to your account once we activate it. Click any symbol for help.

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* Indicates required information

Employer Information
Company Name as it appears on Remittance Advice
Group Number
Sub Group Numbers (Separate Multiple Sub Groups with a ",")
Address Line 1 (Street Address)
Address Line 2
City
State
Zip Code
Office Contact/Manager

User Information
First Name
Last Name
Your roles - check all that apply
Executive (owner/CEO, CFO) Administrative (office mgr, acct/bookkeeper, admin contact) HR (benefits manager, HR manager, HR specialist)
Email Address
Phone ( ) - ext.
Fax ( ) -
Username (6-32 characters)
Password (8+ characters, at least 1 number, case-sensitive)
Password Confirmation
Tools for Employers Select all the tools that you would like associated with your account. Click any tool name to read a description. Employee Inquiry Enrollment Filemart ClientManager^SM ID Card Request Invoices

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