Register for Online Claim Submission

To register, complete the form below and submit. Once we have your information, we will contact you with further instructions. Field with * is a required field.

Which of the following best describes your role: *

Describe your intentions *

I want to submit claims online and check claim status

I only want to check claim status online

User Account Details

First Name *
Last Name *
Email Address *
Password *
Retype Password *
Select a security question *
What elementary school did you attend?
In what city were you born?
What is your mothers maiden name?
Question response *

Business Name *
Business Phone *
Business Extension
Business Fax *
Tax Ids *
(1 per line)
   Physician's Names *
   (1 per line)
   Physician's NPI's
   (1 per line)

In order to verify your identity, please provide the following information on a claim you have filed with us:

Patient's Full Name *
Patient's Date of Birth *

Patient's Date of Service *
Amount Billed *

Comments

AMM On-Line is an internet website that provides authorized users with access to protected health information. Users are restricted from accessing data that is not appropriate to their practice or specialty.

Misuse of AMM On-line information or services will result in restriction or termination of a users account and usage privileges.

I agree to these terms *

Advanced Medical Management

AMM Claims Manager

Register for Online Claim Submission

User Account Details