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To enroll in electronic billing for Workers' Compensation, Auto/No-Fault claims, an Authorized Corporate Representative must fill out the registration information below. Once registration is complete, you will receive a confirmation e-mail which will enable you to Login, add additional Users and begin setting up your Service Locations and Providers. All fields are required.
To begin electronically submitting your New York Workers' Compensation Claims to the New York Workers' Compensation Board and Workers' Compensation carriers, please complete the registration form below.
HIPAA Agreement/NDA
AIGNetwork.com Software User License and NDA
Please register your organization only once.
After you have registered you can add additional users. To do so, please log into your website and click on the ADMIN tab and select "Add Additional User". This screen will allow you to add users who will have access to your web site and claims.
First Name
Last Name
Company Name (Full)
Company Name (Short - 3-16 letters)
This name is used as part of your login ID, so be sure to make it something you can easily remember and enter when logging in!
Contact Phone Number
Tax ID
Submission Type
Paper Claims via Mail
Scanned Claims via SFTP
Electronically
Via MEDENT
Via Eclipse
Not sure - please contact
Via Centricity
ADSC
SequelMed
HST
E-Mail Address
Confirm E-Mail Address
Password (6-16 chars)
Confirm Password
I have read and agree to the terms and conditions of the
HIPAA Business Associates Agreement/Non Disclosure Agreement
I have read and agree to the terms and conditions of the
AIGNetwork.com Software User License and NDA
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