Use of this portal is restricted to authorized medical office personnel. Please do not allow the private health information displayed within to be viewed by non-authorized third parties.

Cimzia

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Use Tab key or Mouse to advance from field to field. Use Enter key or click Create Account when form is completed
Create New Account:
Practice Name:   *   Practice/Physician Tax ID:   *   Select Reimbursement Method:   *
     
      Control Card ID#   

Only one Reimbursement method may be used at a time.
ALL claims will be processed using the selected Reimbursement method.
Please enter the physical address of the practice. No PO Boxes please.
The practice name and address should exactly match documents listed for the physician/practice Tax ID#.
         
Address 1:   * Address 2:
 
City:   * State:   * Zip:   *
         
Phone Number:   * Fax Number:   * Email Address:   *
         
How should we notify you that a Reimbursement has been made (Savings Card funded or EFT deposit in your bank account)?   *  

Contact Information
Contact Name:   * Phone Number:   * Email Address:   *
How can we best reach the contact?   *
Login Information for the Facility
Passwords must be a minimum of 8 characters and contain at least one symbol character.

Thanks for registering! You will be automatically logged into your account. An email will be sent to the contact email listed on this registration. When you receive this email from the IOI program, please click the hyperlink to confirm.

*Required fields
       
Message
 
To order a new kit, simply send an e-mail to IOAcopayordering@pskw.com. Please include your practice name, address, phone, and contact information. Kits will be shipped within 24 to 48 hours.

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