Medical eServices Account Request

** Only 1 Medical eServices Account is permitted for a medical provider group. Please check with your Management to decide on the one Username and Password for which the account will be established. The same Username and Password applies to all of your offices or billing groups that will be utilizing the Medical eServices features.

User Info Vendor Info
*First Name: *Vendor Name:
*Last Name: *Vendor#:
*Daytime Phone#: *Vendor FEID#:
*Username:
Email :
Password:
*Verify Password:

Purpose of Account Request:
*Purpose of Account:

(*) Required field. Account requests are subject to approval by Medical eServices.

CHESAPEAKE EMPLOYERS' INSURANCE CO. 8722 LOCH RAVEN BLVD. TOWSON, MD 21286-2235 410.494.2000 1.800.264.4943     POLICY AND DATA SECURITY