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TPA Registration Instructions


Click on any of the forms or charts below to download them.

TPA Registration Worksheet (pdf)
Downloadable form that may be completed prior to your online TPA Registration.

Starting your TPA Registration
Enter your Federal EIN number in the format of xx-xxxxxxx into the form, then click the Submit button.




Registration Details

New Registrations
If your organization has not registered with us, you will be directed to the TPA Registration form that appears in the below screenshot. Kindly complete all applicable fields and hit the Submit button that appears at the bottom of the form. After submission, you will be returned to a confirmation page and a confirmation email will be sent to your administrative contact email address.

Amending Previous Registrations
If your organization previously registered with us, you will be directed to the TPA Registration form completed with all information that we have on record from your most recent registration. Kindly modify desired fields and hit the Submit button that appears at the bottom of the form. After submission, you will be returned to a confirmation page and a confirmation email will be sent to your administrative contact email address. If the administrative email address was changed, the prior administrative email address will be carbon copied on the confirmation email.








WVA Tax ID: 27-2251833 | WVA NPI: 1699092718


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