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nmhs.ci.healthpay24.cloud Open in urlscan Pro
2606:4700:7::24  Public Scan

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Submitted URL: http://url4130.ci.healthpay24.cloud/ls/click?upn=u001.o7Mq6wufkArdF618TJJv3oqv2zr-2B6XoTza0LaU8Z-2BANoMWqmUVjge9QC-2F9E7aKDj-2BgX7ZC...
Effective URL: https://nmhs.ci.healthpay24.cloud/e/a/717ec924-760b-4080-28dc-08dca79d46a7/?Token=ba7735bc-b547-482f-ac87-d911ec54499c
Submission: On July 20 via manual from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST /actionlink/quicklogin/

<form class="recaptcha-form" style="margin-bottom:30px;" method="post" autocomplete="off" autocorrect="off" autocapitalize="on" action="/actionlink/quicklogin/" novalidate="novalidate">
  <div class="card-header">
    <div class="card-title">
      <div class="title">Quick Pay</div>
    </div>
    <div style="flex-grow:2;"></div>
  </div>
  <div class="form-group" style="padding:0 .75rem;">
    <div class="field-wrapper">
      <div class="input-field" style="width:100%;">
        <input data-val="true" data-val-required=" " type="text" id="LastName" name="LastName" value="">
        <label for="LastName">Patient's Last Name</label>
      </div>
    </div>
    <div class="field-wrapper">
      <div class="input-field" style="width:100%;">
        <input placeholder="MM/DD/YYYY" data-val="true" data-val-required=" " type="text" data-val-date="Use format: MM/DD/YYYY" id="BirthDate" name="BirthDate" value="" maxlength="10">
        <label for="BirthDate" class="active">Patient's Date of Birth</label>
      </div>
    </div>
  </div>
  <div style="clear:both;"></div>
  <input id="9d650e95-e397-48dd-925c-1f3365ffb567" type="hidden" data-val="true" data-val-required="The NotificationMethod field is required." name="NotificationMethod" value="Email">
  <input id="e7a263c4-97cc-4bdd-8282-618aaff16385" type="hidden" name="OpcNotificationEmailId" value="717ec924-760b-4080-28dc-08dca79d46a7">
  <input id="95b3cc80-9087-451d-a843-fb58fcd0a2b5" type="hidden" name="Token" value="ba7735bc-b547-482f-ac87-d911ec54499c">
  <input id="01ac65e3-7b8a-436c-bee1-f71354d251e5" type="hidden" name="Unsubscribe" value="">
  <input id="57b5f42c-d67a-4e4f-8dd5-16df41d20d22" type="hidden" name="TimeZone" value="Europe/Berlin">
  <input id="33243229-e603-42e8-9c00-99aee9c504fe" type="hidden" class="recaptcha-token" name="ReCaptchaToken" value="">
  <div class="validation-summary" style="display:none;">
    <div class="validation-summary-content"></div>
  </div>
  <div style="display:flex; flex-direction:row;">
    <div style="flex-grow:1;"></div>
    <button type="submit" class="btn-login btn primary-accent-background">Access</button>
  </div>
  <input name="__RequestVerificationToken" type="hidden" value="CfDJ8LtAUNNNorFFkxI9bfM0BjYZxzYHlz8d5sYfwDjt2zFBRSudvd4euQ9dhnYvDrTDfV3H-BzQZTHtrzaniajTQGKHweEtrboPh7QGFtoU0T-K0ocvIUOggjfcxb6x8Q-gWmMXHvSimweaxQSVapE6vUk">
</form>

Text Content

402-354-4230
Customer Service



WELCOME

Quick Pay

Patient's Last Name
Patient's Date of Birth



Access
If you have a billing inquiry or concern about a refund, please contact customer
service at 402-354-4230.

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