Group Sign Up
You have reached this page because you are an existing Avesis group that would like to begin
managing its billing and eligibility online. If this is correct please fill out the form below, then click 'Submit.'

This system allows you to view, modify, print and verify your monthly invoices online. (Online payment coming soon!) In addition, your group will maintain all of its own eligibility online in a secure, 100% real-time environment.

What Avesis Group are you with?
Carrier / Group Number:
   Company Name:
   Telephone:

Who will be administering these online services for your company?  *
First Name:
   Last Name:
   User Name (to log in):
E-Mail:
   Confirm E-Mail:
    

What month would you like to begin utilizing Avesis' online services?
 ( The first month you would like to verify an invoice online )

( All fields required )

  * NOTE : IF THE ADMINISTRATOR NAME ENTERED ABOVE DOES NOT MATCH
    THAT OF THE BILLING ADMINISTRATOR CURRENTLY ON FILE WITH US THEN,
    FOR SECURITY PURPOSES, WE MUST VALIDATE THIS REQUEST,
    POSSIBLY DELAYING ACCESS TO THESE ONLINE SERVICES.

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