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.

Your Privacy is Important. Priority Health has a strict Privacy Policy. We will not share your account information with others.

* 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 Requirements: Must be a minimum of 16 characters long. Must contain characters from at least three (3) of these categories: Alpha uppercase characters (A-Z) Alpha lowercase characters (a-z) Numbers (0-9) Special Characters (~!@#$%^&*_-+=`\|(){}[]:;"<>',.?/\) Cannot contain: Your first name, last name, email address, username, or a previously used Priority Health account password.
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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