cloud.provideremail.uhc.com
Open in
urlscan Pro
13.111.140.122
Public Scan
Submitted URL: https://click.provideremail.uhc.com/u/?qs=cd3057475764d1ed656dbde8470f122dd0637bbeea7e80c46b8d8ef17025135832c782771fce73a823e3f2ab58...
Effective URL: https://cloud.provideremail.uhc.com/managepreferences?qs=1ddd24d1e2591600fca4edac3c4d2f16c9ab987a6e28c8be79aa6d2883ba6e2fabf304200f9...
Submission: On March 01 via manual from US — Scanned from DE
Effective URL: https://cloud.provideremail.uhc.com/managepreferences?qs=1ddd24d1e2591600fca4edac3c4d2f16c9ab987a6e28c8be79aa6d2883ba6e2fabf304200f9...
Submission: On March 01 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST https://cloud.provideremail.uhc.com/managepreferences?qs=1ddd24d1e2591600fca4edac3c4d2f16c9ab987a6e28c8be79aa6d2883ba6e2fabf304200f944897cb1fffab75077033a1ad9530c8a2e584e4b676965d912fbfee25782cbbb849b30436927595102d0d1b03404cd148b6b2
<form action="https://cloud.provideremail.uhc.com/managepreferences?qs=1ddd24d1e2591600fca4edac3c4d2f16c9ab987a6e28c8be79aa6d2883ba6e2fabf304200f944897cb1fffab75077033a1ad9530c8a2e584e4b676965d912fbfee25782cbbb849b30436927595102d0d1b03404cd148b6b2"
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="Janet"
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="Perriatt" 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="jperriatt@ochsner.org">
<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">
</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"> EDI Productivity Tools </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="ExchangePlans" type="checkbox" id="ExchangePlans" 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"> Exchange Plans </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="LinkSelfService" type="checkbox" id="LinkSelfService" 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"> UHC Provider Portal </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="VA_CCN_SUB" type="checkbox" id="VA_CCN_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"> Veterans Affairs Community Care Network (VA CCN) </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="SUREST_HEALTH_PLAN_SUB" type="checkbox" id="SUREST_HEALTH_PLAN_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"> Surest Health Plan </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="OTHER_SUB" type="checkbox" id="OTHER_SUB" class="checkbox" onchange="Q4change()">
</td>
</tr>
</tbody>
</table>
</td>
<td align="left" valign="top">
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