Billing Registration

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To use the secured areas of, you must complete the registration form below.

General Person Data

Billing - Specific Person Data

Organization Information

Billing - Specific Organization Data

Terms of use

This is a secured site and is governed by the terms below. Please be aware that the person who is named in this portion of the registration will be responsible for setting up and maintaining all additional users and agrees to the following terms:

Disclaimer: All information on Medica's provider portal is provided “AS IS” and without warranties of any kind. Medica does not warrant that the content of Medica's provider portal is accurate, reliable, error-free, that defects will be corrected, or that Medica's provider portal or its server are free of viruses or other harmful components. If there is any conflict between the information you obtain on Medica's provider portal and your participation agreement with Medica (including the Administrative Requirements and Credentialing Plan), the latter governs.

  • Keep your User ID and Password confidential and do not share it with anyone else.
  • Register only additional personnel within your organization who have a legitimate need to use the secured portions of for doing business with us.
  • Only allow access to the information a user requires to perform his or her job responsibilities.
  • Monitor on a regular basis who within your organization has access to the secured portions of and what transactions such persons have access to. Make all appropriate modifications to each such user's rights.
  • When personnel leave your organization, you or a Secondary Administrator must promptly deactivate that user's account.
  • Advise all users that they are bound by the terms above.