Get Provider Portal New User Request - Catamaran

Filling out the Provider Portal New User Request form is a crucial step for individuals seeking access to important resources. This guide will provide you with detailed, step-by-step instructions to help you complete the form efficiently and accurately.

Follow the steps to successfully fill out the form.

1. Click the ‘Get Form’ button to access the form and open it in the corresponding editor.
2. In the Provider Information section, enter the NCPDP ID or Chain Code(s) relevant to the Provider. Additionally, if applicable, fill in the DEA Number, NPI ID, and Medicaid ID fields.
3. Proceed to the User Information section. Input the first name, last name, and middle initial of the individual who will be receiving access to the Provider Portal.
4. Navigate to the Pharmacy Information section. Fill in the location name, address, city, state, primary phone number, alternate phone number, and zip code.
5. In the Email Address field, provide a valid email for communications related to the Provider Portal.
6. Review the declaration statement regarding the accuracy of the information provided. Ensure that you understand the implications of falsifying information.
7. Sign the document in the User Signature field, certifying your authorization to submit the request. Check the disclaimer acceptance box to confirm your acknowledgment of the terms.
8. Finally, specify the date to indicate when the form is completed. After filling out all sections, you can save your changes, download a copy, print the document, or share it as needed.

Complete your Provider Portal New User Request online today for prompt access.