Login Request Form

Login credentials are needed to access the client portal, claim report system, and medical provider database. If you need a username and password, complete the form below.  Upon validation of your request, you will receive your login credentials within 48 hours.

To optimize access to the claim status and/or to generate reports, use Internet Explorer.

Include the following information on the form below which will be sent as an email to: compliance@nextleveladmin.com 

Fields marked with an * are required.

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