Registration UI

Register

Contact Web Customer Service

Carelon Medical Benefits Management (800) 252-2021

Login Information

First Name *

Last Name *

Email *

Password *

Confirm Password *

Create a password using the following guidelines:

• Use a passphrase (unrelated words)

• Use a combination of letters, numbers, and symbols

• Make the password unique and never used on other applications

• Try not to use parts of a previous password

• Consider this password may have been exposed in unrelated data breaches

Cannot be less than 8 characters

At least one uppercase letter

At least one lowercase letter

At least one number (0-9)

At least one symbol (e.g., !@#$%^&*)

Cannot be the same as Email

User Details

User Role *

Organization Name *

Address 1 *

Address 2 (Optional)

City *

State *

Zip Code *

Contact Email *

Use email from Login information

Phone *

Ext

Max 7 digits

Fax *

Health Plan Details

Please select a User Role first

Terms of Use

I Agree to the Terms of Use

Use of the provider portal indicates agreement with our Privacy Policy Terms of Use

Support Newsletter/Blog