Registration

ATTENTION: If you are a benefits administrator who wants to register for online Eligibility Submissions, please call our Enrollment Department at 800-452-9310.

Step 1: Please create a username that will identify you when you sign on
• Username and password cannot be the same. • * Password must contain 7-10 characters including 3 of the 4 requirements listed below. • English uppercase characters (A through Z) • English lowercase characters (a through z) • Base 10 digits (0 through 9) • Non-alphabetic characters (for example: !, $, #, %)
*Username:	(7-10 char)
*Password:	(7-10 char)
*Retype Password:
	Note: Password is case sensitive.


Step 2: Choose a security question to help us identify you if you forget your password
*Security Question:
*Security Answer:	(One word answer)

Step 3: Choose one of the following registrations
	Dental Office Member
* Required fields are indicated in bold.