iEXCHANGE® Web Password Reset Form

This form should be completed by the assigned office administrator. Providers should complete this form only if the office administrator is unavailable.

Note: Provider includes Physician, Other Professional Provider and Facility Provider.

* All Fields Are Required


* Provider / Office / Group Name:

* Tax ID Number:

* NPI Number:

* Assigned Administrator’s First and Last Name: :

* Contact Phone Number:

* Assigned Administrator’s Email Address:

* Numeric iEXCHANGE ID:

 
 


Note: The iEXCHANGE Help Desk will email the assigned Administrator the User ID, iEXCHANGE ID and temporary password. Please allow five business days for processing.


Updated April 2018