EKRCM
EKRCM
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Client Forms

EKRCM utilizes services by MailHippo for HIPAA Compliance. 

All links below will redirect to a MailHippo Form for enhanced security.

Website Home

New Client Forms

Forms to assist with setup of accounts, handling guidelines, and more! Thank you for completing the forms.

Account Handling Guidelines

Required

Link: ahg.ekrcm.com

Billing Contact

Required

Link: billto.ekrcm.com


Practice Demographics

Required

Link: practice.ekrcm.com


Provider Demographics

Option 1 Required

Link - Two Options:

Option 1 - Basic Data for Billing Only: pq.ekrcm.com

Option 2 - Enhanced Data for Credentialing: provider.ekrcm.com

Please submit one form per provider. For Option 2 please send all supporting and required documentation via secure email in addition to completing the form. Secure email can be sent by going to the following webpage: secure.ekrcm.com


Credentialing Request

Optional

Link: cred.ekrcm.com

Use this to request we start credentialing with a new payer.

Contract Request

Optional

Link: cr.ekrcm.com

Use to request we obtain a copy of your existing insurance contracts from an insurance carrier.

User Request

Optional

Link: newuser.ekrcm.com

Request a new user for your staff for any software provided by EKRCM.


Questions? Give us a call! 888-360-2288


Phone: 888-360-2288

Fax: 888-818-1230

Email: info@ekrcm.com

Mail: PO BOX 56500 Virginia Beach, VA 23456

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