pay.usacsbill.com Open in urlscan Pro
2606:4700::6812:6b3e  Public Scan

URL: https://pay.usacsbill.com/
Submission: On July 01 via manual from US — Scanned from DE

Form analysis 11 forms found in the DOM

POST /set-language/

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POST /set-language/

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POST /set-language/

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POST /set-language/

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POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="Ccl3RPO93xL2VmdgfDftXLJv5vvYlJWPYq3xUQT6Ydl4XLSbTmRXmbNOCMUS3hFQ">
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</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="Ccl3RPO93xL2VmdgfDftXLJv5vvYlJWPYq3xUQT6Ydl4XLSbTmRXmbNOCMUS3hFQ">
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</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="Ccl3RPO93xL2VmdgfDftXLJv5vvYlJWPYq3xUQT6Ydl4XLSbTmRXmbNOCMUS3hFQ">
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</form>

POST /set-language/

<form action="/set-language/" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="Ccl3RPO93xL2VmdgfDftXLJv5vvYlJWPYq3xUQT6Ydl4XLSbTmRXmbNOCMUS3hFQ">
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</form>

POST

<form role="form" method="POST" novalidate="novalidate" class="my-16">
  <input type="hidden" name="csrfmiddlewaretoken" value="Ccl3RPO93xL2VmdgfDftXLJv5vvYlJWPYq3xUQT6Ydl4XLSbTmRXmbNOCMUS3hFQ">
  <label>
    <div class="mt-24 text-gray-65657b text-0_875 font-500"> Bill ID </div>
    <div class="mt-8 " data-test="index-login-form-bill-id-input">
      <input type="text" name="link_id" id="link_id" class="input" placeholder="0000 - 0000 - 0000" data-validations="required regex=[0-9]{12}" data-name="link_id" pattern="[0-9]*" autocomplete="off" aria-required="true" maxlength="14" required="">
    </div>
  </label>
  <label>
    <div class="mt-24 text-gray-65657b text-0_875 font-500"> Date of birth (MM/DD/YYYY) </div>
    <div class="mt-8 " data-test="index-login-form-dob-input">
      <input type="text" name="dob" id="" class="input _dob-l10n" data-name="Date of Birth" data-test="localized-dob-field" data-validations="required regex=\d{1,2}/\d{1,2}/\d{4}" pattern="\d{1,2}/\d{1,2}/\d{4}" placeholder="MM / DD / YYYY"
        autocomplete="off" aria-required="true" inputmode="numeric" required="">
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  </label>
  <div class="bg-primary-f2f8ff rounded-12 mt-24 p-16" style="font-size: 1.05rem">
    <div class="flex flex-row">
      <label class="cursor-pointer flex">
        <input type="checkbox" name="show_paperless_modal" class="checkbox" id="show_paperless_modal" checked="">
        <span class="pl-16 text-gray-171731 cursor-pointer font-500 text-1 leading-1_5 tracking-0_2"> Simplify. Go paperless. </span>
      </label>
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    <div class="ml-40 mt-8"> Simplify your life with instant bill notifications and securely manage your medical bills online. </div>
  </div>
  <button id="verify" type="submit" class="btn btn-primary mt-32" data-test="index-login-form-verify-btn"> View bill </button>
</form>

POST /set-language/

<form action="/set-language/" method="post">
  <input type="hidden" name="csrfmiddlewaretoken" value="Ccl3RPO93xL2VmdgfDftXLJv5vvYlJWPYq3xUQT6Ydl4XLSbTmRXmbNOCMUS3hFQ">
  <input type="hidden" name="language" value="en">
  <input type="hidden" name="next" value="/">
  <input class="text-left bg-white capitalize px-24 py-8 w-full hover:bg-gray-f3f4f7  text-primary-3667e9 font-500" type="submit" value="English">
</form>

POST /set-language/

<form action="/set-language/" method="post">
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  <input type="hidden" name="language" value="es">
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  <input class="text-left bg-white capitalize px-24 py-8 w-full hover:bg-gray-f3f4f7 text-gray-65657b" type="submit" value="español">
</form>

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WELCOME TO US ACUTE CARE SOLUTIONS


PAY YOUR CLINICIAN BILLS ONLINE EASILY AND SECURELY

If you've received a paper bill, you can quickly log in by using the 12-digit
Bill ID found at the top of your bill.



VIEW YOUR BILL ONLINE

All fields are required unless stated otherwise
Bill ID

Date of birth (MM/DD/YYYY)

Simplify. Go paperless.
Simplify your life with instant bill notifications and securely manage your
medical bills online.
View bill
Don't know your Bill ID?
Find your account
If you've received a paper bill, you can quickly log in by using the 12-digit
Bill ID found at the top of your bill.

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