New Third Party Credentialer Vantage® account Authorization

It is the responsibility of the credentialing company to request access be revoked for any user who should no longer have access to this information.

Vantage® Accounts are issued when the information supplied has been validated. This process usually takes one to three business after submitting your request.

When the information has been validated, logon information will be emailed to Credentialer Email Address specified on this form.

Our normal business hours are:
Monday - Friday 8 a.m. - 5 p.m. CT

Thank you,
SVMIC Vantage® Team

 

Your Information

Your Name *
Your Email Address *

 

Credentialing Company Information

Company Name *
Contact Telephone Number * (999-999-9999)
Street Address *
City *
State *
Zip *

 

Credentialer Information

If your company has multiple credentialer locations, we ask that you please complete a form for each location listing the appropriate credentialers who are associated with that location address.

Credentialer email addresses must be a individual company email address. Personal or shared email addresses are not allowed.

Credentialer Name *
Credentialer Email Address *

Please enter the number above

By clicking the box below, you are certifying that your request is valid. Completing this form under false or fraudulent pretenses is subject to legal action.

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