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.
* indicates a required field
TAX ID #:
Facility/Office Mgr Phone:
This user will utilize the following services: (must choose at least one)
Authorizations - View
Authorizations - Submit
Claims & PRAs
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.
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