Registration/Access Permission Form

This form is for users not directly employed by internal Global TPA to register with the HEDIS® web site. You must fill out ALL of the the items marked with a Red (*) from each section below before submitting a request.

Personal Information

Address Information

Company Information

Access Request Detail

Group User: Select this option to request access to a particular Physician(s) HEDIS® member’s profile.
IPA User: Select this option to obtain access to all physicians under a particular IPA.

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