CIC Bills Processing

Carisk Intelligent Clearinghouse Registration

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To Create a CiC Account and Begin Electronic Billing for Workers' Compensation and/or Auto Claims, an Authorized Representative Must Enter the Requested Information Below.

Once Registration is Complete, You May Log into Your Account. The CiC “Setup Wizard” will Help You Complete Your Account Setup.

Registration

First Name

First Name is required.

Last Name

Last Name is required.

Full Organization Name

Organization Name is required.

Account Username Handle Note: the account handle will be part of every user's name. It should be a nickname that represents the account as a whole, not the person registering.

Account Username Handle is required.
You must enter a valid short company name containing only letters. No numbers, spaces, or other symbols are allowed.

Contact Phone Number

Contact Phone is required
You must enter a valid, 10-digit phone number.

E-Mail Address

EMail Address is required
You must enter a valid e-mail address.

Confirm E-Mail Address

Confirm EMail Addresses is required
EMail Addresses do not match

Password

Password is required
You must enter a password that contains between 8 and 15 characters, with at least one upper and lower case letter and one symbol.

Confirm Password

Confirm Password is required
Passwords do not match

Submission Type

The Submission type must be selected.

Billing Company Name

Tax ID Number

Please enter a valid, 9-digit tax ID that contains no non-numeric characters.

Organization Address

Requested Demo Date

City

State

State is required

Zip Code

Approx. # Monthly Bill Submissions

Approx. # Rendering Providers

Please enter only numeric values

Approx. # Service Facilities

Please enter only numeric values

HIPAA Business Associates Agreement / NDA
CIC Software User License Agreement / NDA

I have read & agree to the terms & conditions of the HIPAA Business Associates Agreement / NDA
I have read & agree to the terms & conditions of the CiC Software User License Agreement / NDA

Carisk Intelligent Clearinghouse Registration

Registration

CONTACT INFO