Consolidated Billing Registration

Facility Name*

Contact First Name*

Contact Last Name*

Contact Phone*

Customer Account Number*

Recent Invoice Number*

Emails*

Is it okay to use the above email addresses to send customer billing communications?*Please Select...YesNoTo conveniently pay your invoice visit the Change Healthcare Online Payment Portal at https://finservices.changehealthcare.com/OA_HTML/SelfRegistration.jsp

Your Email**Email address of the person submitting this request: