Facility Type(s) *
Select which state(s) you own/operate facilities *
Check the box if you are changing the Authorized decision maker (Member Representative) or Billing contact on file.

Service Area Registration/Mapping Contact Information

Individual within your company who is authorized to make changes to your company’s Service Area Registration (SAR). This individual will have login credentials to access the Member Polygon Maintenance tool.

Service Area Registration/Mapping Contact Information