The University of Arizona Health Plans
 
Wednesday, August 23, 2017 7:57 PM
eServices Registration
 
Instructions:
Please complete all fields on the Registration form. In the "Account Info" section, you must enter one Tax ID Number with a valid Provider AHCCCS ID* and Plan Name. You must also accept the The University of Arizona Health Plans Online Agreement in order to be granted access to the eServices website.

** Tax ID must be 9 numeric values.

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All Fields Required.
 ACCOUNT INFO
Account Verification: 
** Tax ID Number Provider AHCCCS ID Plan Name
   
Password Question: 
Password Answer:   
 
 CONTACT INFO
First Name:   
Last Name:   
E-mail Address:   
Contact Phone:     
 OFFICE LOCATION
Office Address 1:   
Office Address 2: 
City:   
State: 
Postal Code:   
 The University of Arizona Health Plans ONLINE AGREEMENT
Read Agreement: 
Accept Agreement:     
Print Agreement:  The University of Arizona Health Plans Online Agreement
 SUBMIT REGISTRATION
 
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