MediExcel
CLIENT ACCESS PORTAL
USER ID REQUEST FORM

MediExcel Health Plan's (MEHP) Client Access Portal allows Large Group clients to verify employee eligibility and applicable monthly premium information.

For access, please designate a single primary user. The Primary User ID is non-transferable, and MediExcel Health Plan must be notified immediately of any changes.

COMPANY BUSINESS INFORMATION
COMPANY PRIMARY ADMINISTRATOR INFORMATION
New Administrator Change Administrator

Please Note: A temporary password will be sent to the administrator within 3 business days. Once the temporary password is received, please have administrator reset and personalize. Please keep the final personalized password in your records for future reference or in the event that authentication is required.

COMPANY AUTHORIZED CONTRACT SIGNER INFORMATION.

MediExcel Health Plan may provide personal Health Information (PHI) only to those third parties who are identified by as its business associates. MEHP must receive written assurances from the grop that a business associate agreement exist between the group and the third party and that the business associate agreement permits the business associate to receive requested PHI information from MEHP. By signing below, the group agrees that a business associate agreement exists, MEHP may disclose PHI to the third party as necessary to provide services for or an behalf of the group, and the group will immediately inform MEHP when the business associate has been terminated.


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