MCSOnline Access Request Form

Managed Care Systems, LLC (MCS) has installed various Information Technology resources allowing computerization of information.  The utilization of these automated systems will communicate information to authorized users more efficiently and effectively, leading to quality improvement in patient care and business services.  In order to protect the information contained in the MCS databases and to prevent unauthorized use of all information, access to these Information Technology resources will be limited to those persons who are issued an access code by MCS.

Account Information

* indicates a required field

* Last Name:

 

* First Name:

 
Middle Initial:

* Email:

 

* Job Title:

 

* Company:

 
*
 

* Rep. Phone:

  Ext: 

 

Fax:


This user will utilize the following services: (must choose at least one)



This user will need access to the following Lines of Business (must choose at least one):













List Providers accesible by this account (use comma between multiple providers):

IMPORTANT!
Submitting this form will send your access request to the proper team at Managed Care Systems who will review your request.
You should also receive a confirmation email to the address provided stating we have received your request. If you do not receive this confirmation email within
24 hours please contact your Provider Relations representative or call (661) 716-7100.
Upon finalization of the request you will receive notification via the email provided. If you have questions concerning this request, please contact
your Provider Relations representative or call (661) 716-7100.