cloud.provideremail.uhc.com Open in urlscan Pro
13.111.140.122  Public Scan

Submitted URL: https://click.provideremail.uhc.com/?qs=d0a862515a5ee63ba90265644e6089048b4ffb731e13f99a27bb9b01529ce4e22af4561781d8f1085a5eb0a3d5c5...
Effective URL: https://cloud.provideremail.uhc.com/managepreferences?qs=0e8c1d579046a06017af31530b88f430bee2764257d2d6d2a8eb91c3d63868d57f043bab498...
Submission: On November 03 via api from US — Scanned from DE

Form analysis 1 forms found in the DOM

POST https://cloud.provideremail.uhc.com/managepreferences?qs=0e8c1d579046a06017af31530b88f430bee2764257d2d6d2a8eb91c3d63868d57f043bab4987d23938e16981f1ad745a618cf0aaaf1ea72430f3db26d1f40b71e858de001b2aa8907ca7fd3e62593dc369fda5fe7b7583eb

<form action="https://cloud.provideremail.uhc.com/managepreferences?qs=0e8c1d579046a06017af31530b88f430bee2764257d2d6d2a8eb91c3d63868d57f043bab4987d23938e16981f1ad745a618cf0aaaf1ea72430f3db26d1f40b71e858de001b2aa8907ca7fd3e62593dc369fda5fe7b7583eb"
  method="post" class="needs-validation" validate="">
  <!--Background color table-->
  <table width="100%" border="0" cellpadding="0" cellspacing="0" align="center" style="margin:0; padding:0;">
    <tbody>
      <tr>
        <td>
          <div align="center">
            <table border="0" cellpadding="0" cellspacing="0" align="center" id="mainbody" style="width:900px;">
              <tbody>
                <tr>
                  <td>
                    <table width="100%" border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse;">
                      <!-- spacer row -->
                      <tbody>
                        <tr>
                          <td>
                            <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                          </td>
                        </tr>
                        <!-- End spacer row -->
                        <!-- UHC Lo row -->
                        <tr>
                          <td>
                            <table border="0" cellspacing="0" cellpadding="0" align="left" id="unitedhealthlogo">
                              <tbody>
                                <tr>
                                  <td valign="top" align="left">
                                    <img src="https://image.provideremail.uhc.com/lib/fe3f11727564047d741c70/m/1/UHC_MB_Lockup_blu_RGB200x62.png" alt="UnitedHealthcare">
                                  </td>
                                </tr>
                              </tbody>
                            </table>
                          </td>
                        </tr>
                        <!-- spacer row -->
                        <tr>
                          <td>
                            <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                          </td>
                        </tr>
                        <!-- End spacer row -->
                        <tr>
                          <td>
                            <table width="100%" bgcolor="#003DA1" cellpadding="0" cellspacing="0" border="0">
                              <tbody>
                                <tr>
                                  <td align="left" valign="top" bgcolor="#E5F8FB">
                                    <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                                    <table>
                                      <tbody>
                                        <tr>
                                          <td style="font-size:18px; color: #002677; font-family:Georgia,serif; padding: 0px 0px 6px 20px;">
                                            <b>
                                        Get personalized news
                                      </b>
                                            <br>
                                          </td>
                                        </tr>
                                      </tbody>
                                    </table>
                                    <table>
                                      <tbody>
                                        <tr>
                                          <td style="font-size:14px; color: rgb(68, 68, 68); font-family:Arial,Helvetica,sans-serif; padding: 0px 0px 6px 20px;"> When you share your preferences with us, we can tailor your Network News experience to
                                            receive only the news that is relevant to you. </td>
                                        </tr>
                                      </tbody>
                                    </table>
                                    <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                                  </td>
                                </tr>
                              </tbody>
                            </table>
                          </td>
                        </tr>
                      </tbody>
                    </table>
                    <!-- end UHC logo -->
                  </td>
                </tr>
                <tr>
                  <td>
                    <!-- body -->
                    <table width="100%" border="0" cellspacing="0" cellpadding="0" align="left" id="bodycol">
                      <tbody>
                        <tr>
                          <td valign="top" align="left">
                            <table width="100%" cellpadding="0" cellspacing="0" border="0">
                              <tbody>
                                <tr>
                                  <td valign="top" align="left" style="padding: 14px;">
                                    <table width="100%" cellpadding="0" cellspacing="0" border="0">
                                      <tbody>
                                        <tr>
                                          <td valign="top" align="left">
                                            <div class="required-fields">
                                            </div>
                                            <table width="100%" cellpadding="0" cellspacing="0" border="0">
                                              <tbody>
                                                <tr>
                                                  <td class="drop" valign="top" align="left">
                                                    <table width="290px" cellpadding="0" cellspacing="0" border="0">
                                                      <tbody>
                                                        <tr>
                                                          <td class="drop form-label" width="25%" valign="middle" align="left" style="color: #333333; font-size: 14px; font-weight: 600;"> First Name <sup class="req">*</sup>
                                                          </td>
                                                        </tr>
                                                        <tr>
                                                          <td class="drop pb-10" valign="middle" align="left">
                                                            <input style="border:1px solid #002677; width:290px; height:35px; font-size: 13.5px; border-radius:2px;" class="form-control" pattern="[^|]+" type="text" name="First_Name" value="Julie"
                                                              required="">
                                                            <div class="invalid-feedback" style="color: #cf0000; font-size: 14px; font-weight: 500;">Please fill out this field. </div>
                                                          </td>
                                                        </tr>
                                                      </tbody>
                                                    </table>
                                                  </td>
                                                  <td class="drop" valign="top" align="left">
                                                    <table width="290px" cellpadding="0" cellspacing="0" border="0">
                                                      <tbody>
                                                        <tr>
                                                          <td class="drop form-label" width="25%" valign="middle" align="left" style="color: #333333; font-size: 14px; font-weight: 600;"> Last Name <sup class="req">*</sup>
                                                          </td>
                                                        </tr>
                                                        <tr>
                                                          <td class="drop pb-10" valign="middle" align="left">
                                                            <input style="border:1px solid #002677; width:290px; height:35px; font-size: 13.5px; border-radius:2px;" class="input-fields require" pattern="[^|]+" type="text" name="LastName"
                                                              value="Mccausland" required="">
                                                            <div class="invalid-feedback" style="color: #cf0000; font-size: 14px; font-weight: 500;">Please fill out this field. </div>
                                                          </td>
                                                        </tr>
                                                      </tbody>
                                                    </table>
                                                  </td>
                                                </tr>
                                                <tr>
                                                  <td class="hide-this" colspan="2">
                                                    <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                                                  </td>
                                                </tr>
                                                <tr>
                                                  <td class="drop" valign="top" align="left">
                                                    <table width="290px" cellpadding="0" cellspacing="0" border="0">
                                                      <tbody>
                                                        <tr>
                                                          <td class="drop form-label" width="25%" valign="middle" align="left" style="color: #333333; font-size: 14px; font-weight: 600;"> Email <sup class="req">*</sup>
                                                          </td>
                                                        </tr>
                                                        <tr>
                                                          <td class="drop pb-10" valign="middle" align="left">
                                                            <input style="border:1px solid #002677; width:290px; height:35px; font-size: 13.5px; border-radius:2px;" class="input-fields require" id="email" type="email" pattern="[^|]+"
                                                              name="EmailAddress" value="mccauslandj2@upmc.edu">
                                                            <div class="invalid-feedback" style="color: #cf0000; font-size: 14px; font-weight: 500;">Please fill out this field. </div>
                                                          </td>
                                                        </tr>
                                                      </tbody>
                                                    </table>
                                                  </td>
                                                  <td class="drop" valign="top" align="left">
                                                    <table width="290px" cellpadding="0" cellspacing="0" border="0">
                                                      <tbody>
                                                        <tr>
                                                          <td class="drop form-label" width="25%" valign="middle" align="left" style="color: #333333; font-size: 14px; font-weight: 600;"> Preferred Primary Specialty <sup class="req">*</sup>
                                                          </td>
                                                        </tr>
                                                        <tr>
                                                          <td class="drop pb-10" valign="middle" align="left">
                                                            <select id="Specialty" class="require" name="Specialty"
                                                              style="font-size:13.5px; padding:2px 0px 2px 0px; text-align:left;  width:290px; height:35px; border:1px solid #002677;border-radius:2px;" required="">
                                                              <option value="">Select One</option>
                                                              <option value="Allergy">Allergy</option>
                                                              <option value="Behavioral Health – Psychiatrists">Behavioral Health – Psychiatrists</option>
                                                              <option value="Behavioral Health – Psychologists">Behavioral Health – Psychologists</option>
                                                              <option value="Behavioral Health – Other Professionals">Behavioral Health – Other Professionals</option>
                                                              <option value="Cardiology">Cardiology</option>
                                                              <option value="Chiropractic Medicine">Chiropractic Medicine</option>
                                                              <option value="Dermatology">Dermatology</option>
                                                              <option value="Endocrinology">Endocrinology</option>
                                                              <option value="Gastroenterology">Gastroenterology</option>
                                                              <option value="Genetics">Genetics</option>
                                                              <option value="Hematology">Hematology</option>
                                                              <option value="Hospital Based Specialists">Hospital Based Specialists</option>
                                                              <option value="Infectious Disease Medicine">Infectious Disease Medicine</option>
                                                              <option value="MidLevel Clinicians">MidLevel Clinicians</option>
                                                              <option value="Neonatology">Neonatology</option>
                                                              <option value="Nephrology">Nephrology</option>
                                                              <option value="Nursing">Nursing</option>
                                                              <option value="OB/GYN">OB/GYN</option>
                                                              <option value="Occupational/Physical Therapists">Occupational/Physical Therapists</option>
                                                              <option value="Oncology">Oncology</option>
                                                              <option value="Opthamology">Ophthalmology</option>
                                                              <option value="Orthopaedic Surgery">Orthopedic Surgery</option>
                                                              <option value="Other Specialists">Other Specialists</option>
                                                              <option value="Otorhinolaryngology">Otorhinolaryngology</option>
                                                              <option value="Pediatric Specialists">Pediatric Specialists</option>
                                                              <option value="Podiatry">Podiatry</option>
                                                              <option value="Preventive Medicine">Preventive Medicine</option>
                                                              <option value="Primary Care - Family Practice">Primary Care - Family Practice</option>
                                                              <option value="Primary Care - General Practice">Primary Care - General Practice</option>
                                                              <option value="Primary Care - Geriatrics">Primary Care - Geriatrics</option>
                                                              <option value="Primary Care - Internal Medicine">Primary Care - Internal Medicine</option>
                                                              <option value="Primary Care - Pediatrics">Primary Care - Pediatrics</option>
                                                              <option value="Psychiatrists">Psychiatrists</option>
                                                              <option value="Psychologists">Psychologists</option>
                                                              <option value="Pulmonary Medicine">Pulmonary Medicine</option>
                                                              <option value="Radiology">Radiology</option>
                                                              <option value="Rheumatology">Rheumatology</option>
                                                              <option value="Surgery - General">Surgery - General</option>
                                                              <option value="Surgery - Specialized">Surgery - Specialized</option>
                                                              <option value="Urgent Care">Urgent Care</option>
                                                              <option value="Urology">Urology</option>
                                                              <option value="Other">Other</option>
                                                            </select>
                                                            <div class="invalid-feedback" style="color: #cf0000; font-size: 14px; font-weight: 500;">Please fill out this field. </div>
                                                          </td>
                                                        </tr>
                                                      </tbody>
                                                    </table>
                                                  </td>
                                                </tr>
                                                <tr>
                                                  <td class="hide-this" colspan="2">
                                                    <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                                                  </td>
                                                </tr>
                                                <tr>
                                                  <td class="drop" valign="top" align="left">
                                                    <table width="290px" cellpadding="0" cellspacing="0" border="0">
                                                      <tbody>
                                                        <tr>
                                                          <td class="drop form-label" width="25%" valign="middle" align="left" style="color: #333333; font-size: 14px; font-weight: 600;"> Role <sup class="req">*</sup>
                                                          </td>
                                                        </tr>
                                                        <tr>
                                                          <td class="drop pb-10" valign="middle" align="left">
                                                            <select id="ROLE" class="require" name="ROLE" style="font-size:13.5px; padding:2px 0px 2px 0px; text-align:left;  width:290px; height:35px; border:1px solid #002677;border-radius:2px;"
                                                              required="">
                                                              <option value="">Select One</option>
                                                              <option value="Practice Staff">Practice Staff</option>
                                                              <option value="Office Manager/Practice Administrator">Office Manager/Practice Administrator</option>
                                                              <option value="Billing Staff">Billing Staff</option>
                                                              <option value="Prior Authorization/Referral Staff">Prior Authorization/Referral Staff</option>
                                                              <option value="Credentialing/Contracting Staff">Credentialing/Contracting Staff</option>
                                                              <option value="Admission/Intake/Scheduling Staff">Admission/Intake/Scheduling Staff</option>
                                                              <option value="Clinicians">Clinicians</option>
                                                              <option value="Physician">Physician</option>
                                                              <option value="Advanced Practice Clinician">Advanced Practice Clinician (Nurse Practitioner, Physician Assistant, etc.)</option>
                                                              <option value="Registered Nurse">Registered Nurse</option>
                                                              <option value="Pharmacist">Pharmacist</option>
                                                              <option value="Dentist">Dentist</option>
                                                              <option value="Medical Assistant">Medical Assistant</option>
                                                              <option value="Other">Other</option>
                                                            </select>
                                                            <div class="invalid-feedback" style="color: #cf0000; font-size: 14px; font-weight: 500;">Please fill out this field. </div>
                                                          </td>
                                                        </tr>
                                                      </tbody>
                                                    </table>
                                                  </td>
                                                </tr>
                                                <tr>
                                                  <td class="hide-this" colspan="2">
                                                    <img alt="" src="https://image.unitedhealthcare-hmhb.com/lib/fe631570726c05787512/m/2/spacer.gif" width="1" height="20" border="0" style="display: block;">
                                                  </td>
                                                </tr>
                                                <tr>
                                                  <td colspan="2" valign="top" align="left" style="font-size: 12px;">
                                                    <table width="100%" cellpadding="0" cellspacing="0" border="0">
                                                      <tbody>
                                                        <tr>
                                                          <td valign="top" align="left">
                                                          </td>
                                                        </tr>
                                                        <tr>
                                                          <td colspan="2" valign="top" align="left">
                                                            <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcontainer">
                                                              <tbody>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top" style="font-size: 14px;padding: 5% 10% 2% 0;">
                                                                            <strong>Interests</strong>
                                                                            <br>You may select more than one interest if preferred.
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                              </tbody>
                                                            </table>
                                                            <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcontainer">
                                                              <tbody>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="PRIOR_AUTH_SUB" type="checkbox" id="PRIOR_AUTH_SUB" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Advanced Notification / Prior Authorization </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="ClaimsInformation" type="checkbox" id="ClaimsInformation" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Claims Information </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="MedicalPolicyUpdates" type="checkbox" id="MedicalPolicyUpdates" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Medical Policy Updates </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="PharmacyUpdates" type="checkbox" id="PharmacyUpdates" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Pharmacy Updates </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input type="checkbox" name="Oxford" id="Oxford" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Oxford </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="Medicare" type="checkbox" id="Medicare" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Medicare </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="Medicaid" type="checkbox" id="Medicaid" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Medicaid </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="Commercial" type="checkbox" id="Commercial" class="checkbox">
                                                                          </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                  <td align="left" valign="top">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checktext">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top"> Commercial </td>
                                                                        </tr>
                                                                      </tbody>
                                                                    </table>
                                                                  </td>
                                                                </tr>
                                                                <tr>
                                                                  <td width="26" align="left" valign="top">
                                                                  </td>
                                                                  <td width="26" align="left" valign="top" style="padding: 7px 0 0 0;">
                                                                    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="checkcheck">
                                                                      <tbody>
                                                                        <tr>
                                                                          <td align="left" valign="top">
                                                                            <input name="EDI_SUB" type="checkbox" id="EDI_SUB" class="checkbox">
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