New Account Setup

Complete the steps below to setup a new account with UHIN

This includes:

TPN Setup, Contracts, and Enrollment

Provider Clearinghouse Agreement

Complete the Enrollment ECA Form

Download form

Complete ECA Amendment (Option 1)

Download form
Notice of Delegation

Complete Notice of Delegation

Download form

Complete Enrollment Form

Download form
Send us
your forms

Send completed ECA form, Notice of Delegation form and Enrollment form to UHIN's Enrollment Team via:


Fax: 877-693-4161

Mail to:
UHIN Enrollment Team
1226 East 6600 South
Salt Lake City, UT 84121

Please double check to see if you are sending the newly saved, SIGNED version of your document.
Thank you.


You can expect a response from UHIN within 4 Business Days.

In the meantime you can expect:
A welcome email from the Enrollment Team
Our Corporate Trainer will reach out to you
You will receive User IDs and Passwords
You will receive status updates on your selected Payers

If you haven't heard back within this timeframe, please contact us at

  • What forms are needed to create an account with UHIN?

    1. Electronic Commerce Agreement (ECA)

    2. Notice of Delegation

    3. UHIN Enrollment Form

    4. Amendment A

  • What if I don't want a Delegate on my Account?

    Simply fill out the top portion of the form and leave the middle section blank. Sign the bottom of the form.

  • Why do you need to know the estimated number of claims per year?

    This information is used to determine pricing for the first year.

  • Do I need to sign up for all of the payers?

    You can sign up for the payers you know you are going to be billing. If you need to add payers later, you can do so by filling out a Clearinghouse Service Change Form.