You must complete all required fields on the form as indicated in red


Online Provider Account Registration

MVP's secure provider account offers online access to member eligibility, benefits, claims, check authorizations,
policy information and more.

To receive access, your practice and / or site must:

  • Be credentialed with MVP (participating providers), or
  • Have a paid claim with MVP (non-paricipating providers)

Note: To view information for Cigna patients, please go to cignaforhcp.com

Office Site Administrator / Individual User Website Access

i To request access for Individual Users acting on behalf of the named provider entity, this form must be
completed by the Office Site Administrator.

Need technical support?

Contact us for assistance with the following:
  • Identifying current site administrator
  • Changing site administrator accounts
  • Any other registration or
    maintainence questions
  • Send us an email

  • 1-888-656-5695

    Monday - Friday, 8.30 am to 5.00pm
    (Eastern Time)

1. Site Administrator Information
     Complete this section for all requests.

Facility/Practice Name Facility/Practice Name is required and cannot contain any special characters
Tax ID Tax ID is required and must be in xxxxxxxxx format (ex.123450001)

2. User Information

Level of Access Select Level of Access
First Name First Name is required and cannot contain any special characters Last Name Last Name is required and cannot contain any special characters
Email Address Email is required and must be in xxx@xx.com format (ex.test@mvp.com)
User's Phone Phone must be in xxx-xxx-xxxx format (ex.123-456-7890) Ext.

3. Submit Electronic Signature