meridianhs.meridianhshrmdirect.com
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104.130.255.68
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Submitted URL: https://billpay.meridianhshrmdirect.com/
Effective URL: https://meridianhs.meridianhshrmdirect.com/bill-pay
Submission: On September 04 via automatic, source certstream-suspicious
Effective URL: https://meridianhs.meridianhshrmdirect.com/bill-pay
Submission: On September 04 via automatic, source certstream-suspicious
Form analysis 3 forms found in the DOM
GET https://meridianhs.meridianhshrmdirect.com/
<form role="search" method="get" class="search-form" action="https://meridianhs.meridianhshrmdirect.com/">
<div class="search-form__inner">
<label>
<span class="screen-reader-text">Search for:</span>
<input type="search" class="search-field" placeholder="Search …" value="" name="s">
</label>
<button type="submit" class="search-submit button">
<i class="fas fa-search" aria-hidden="true"></i>
<span class="screen-reader-text">Search</span>
</button>
</div>
</form>POST /bill-pay/
<form method="post" enctype="multipart/form-data" id="gform_5" action="/bill-pay/">
<div class="gform_body gform-body">
<ul id="gform_fields_5" class="gform_fields top_label form_sublabel_below description_below">
<li id="field_5_1" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label gfield_label_before_complex">Patient's Name:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name" id="input_5_1">
<span id="input_5_1_3_container" class="name_first">
<input type="text" name="input_1.3" id="input_5_1_3" value="" aria-label="First name" aria-required="true">
<label for="input_5_1_3">First</label>
</span>
<span id="input_5_1_6_container" class="name_last">
<input type="text" name="input_1.6" id="input_5_1_6" value="" aria-label="Last name" aria-required="true">
<label for="input_5_1_6">Last</label>
</span>
</div>
</li>
<li id="field_5_2" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label" for="input_5_2">Patient's Account Number:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_text"><input name="input_2" id="input_5_2" type="text" value="" class="medium" aria-required="true" aria-invalid="false"> </div>
</li>
<li id="field_5_3" class="gfield gfield_price gfield_price_5_3 gfield_product_5_3 gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label" for="input_5_3">Payment Amount:<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_product_price">
<input name="input_3" id="input_5_3" type="text" value="" class="medium ginput_amount" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_5_4" class="gfield field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label">Patient's Date of Birth:</label>
<div id="input_5_4" class="ginput_container ginput_complex">
<div class="clear-multi">
<div class="gfield_date_dropdown_month ginput_container ginput_container_date" id="input_5_4_1_container"><select name="input_4[]" id="input_5_4_1" aria-required="false" aria-label="Month">
<option value="">Month</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select></div>
<div class="gfield_date_dropdown_day ginput_container ginput_container_date" id="input_5_4_2_container"><select name="input_4[]" id="input_5_4_2" aria-required="false" aria-label="Day">
<option value="">Day</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select></div>
<div class="gfield_date_dropdown_year ginput_container ginput_container_date" id="input_5_4_3_container"><select name="input_4[]" id="input_5_4_3" aria-required="false" aria-label="Year">
<option value="">Year</option>
<option value="2022">2022</option>
<option value="2021">2021</option>
<option value="2020">2020</option>
<option value="2019">2019</option>
<option value="2018">2018</option>
<option value="2017">2017</option>
<option value="2016">2016</option>
<option value="2015">2015</option>
<option value="2014">2014</option>
<option value="2013">2013</option>
<option value="2012">2012</option>
<option value="2011">2011</option>
<option value="2010">2010</option>
<option value="2009">2009</option>
<option value="2008">2008</option>
<option value="2007">2007</option>
<option value="2006">2006</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
</select></div>
</div>
</div>
</li>
<li id="field_5_5" class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible">
<h2 class="gsection_title">Credit Card Billing Information</h2>
</li>
<li id="field_5_6" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label gfield_label_before_complex">Name:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name" id="input_5_6">
<span id="input_5_6_3_container" class="name_first">
<input type="text" name="input_6.3" id="input_5_6_3" value="" aria-label="First name" aria-required="true">
<label for="input_5_6_3">First</label>
</span>
<span id="input_5_6_6_container" class="name_last">
<input type="text" name="input_6.6" id="input_5_6_6" value="" aria-label="Last name" aria-required="true">
<label for="input_5_6_6">Last</label>
</span>
</div>
</li>
<li id="field_5_7" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label gfield_label_before_complex">Address:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address" id="input_5_7">
<span class="ginput_full address_line_1 ginput_address_line_1" id="input_5_7_1_container">
<input type="text" name="input_7.1" id="input_5_7_1" value="" aria-required="true">
<label for="input_5_7_1" id="input_5_7_1_label">Street Address</label>
</span><span class="ginput_full address_line_2 ginput_address_line_2" id="input_5_7_2_container">
<input type="text" name="input_7.2" id="input_5_7_2" value="" aria-required="false">
<label for="input_5_7_2" id="input_5_7_2_label">Address Line 2</label>
</span><span class="ginput_left address_city ginput_address_city" id="input_5_7_3_container">
<input type="text" name="input_7.3" id="input_5_7_3" value="" aria-required="true">
<label for="input_5_7_3" id="input_5_7_3_label">City</label>
</span><span class="ginput_right address_state ginput_address_state" id="input_5_7_4_container">
<select name="input_7.4" id="input_5_7_4" aria-required="true">
<option value=""></option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="Arizona">Arizona</option>
<option value="Arkansas">Arkansas</option>
<option value="California">California</option>
<option value="Colorado">Colorado</option>
<option value="Connecticut">Connecticut</option>
<option value="Delaware">Delaware</option>
<option value="District of Columbia">District of Columbia</option>
<option value="Florida">Florida</option>
<option value="Georgia">Georgia</option>
<option value="Hawaii">Hawaii</option>
<option value="Idaho">Idaho</option>
<option value="Illinois">Illinois</option>
<option value="Indiana" selected="selected">Indiana</option>
<option value="Iowa">Iowa</option>
<option value="Kansas">Kansas</option>
<option value="Kentucky">Kentucky</option>
<option value="Louisiana">Louisiana</option>
<option value="Maine">Maine</option>
<option value="Maryland">Maryland</option>
<option value="Massachusetts">Massachusetts</option>
<option value="Michigan">Michigan</option>
<option value="Minnesota">Minnesota</option>
<option value="Mississippi">Mississippi</option>
<option value="Missouri">Missouri</option>
<option value="Montana">Montana</option>
<option value="Nebraska">Nebraska</option>
<option value="Nevada">Nevada</option>
<option value="New Hampshire">New Hampshire</option>
<option value="New Jersey">New Jersey</option>
<option value="New Mexico">New Mexico</option>
<option value="New York">New York</option>
<option value="North Carolina">North Carolina</option>
<option value="North Dakota">North Dakota</option>
<option value="Ohio">Ohio</option>
<option value="Oklahoma">Oklahoma</option>
<option value="Oregon">Oregon</option>
<option value="Pennsylvania">Pennsylvania</option>
<option value="Rhode Island">Rhode Island</option>
<option value="South Carolina">South Carolina</option>
<option value="South Dakota">South Dakota</option>
<option value="Tennessee">Tennessee</option>
<option value="Texas">Texas</option>
<option value="Utah">Utah</option>
<option value="Vermont">Vermont</option>
<option value="Virginia">Virginia</option>
<option value="Washington">Washington</option>
<option value="West Virginia">West Virginia</option>
<option value="Wisconsin">Wisconsin</option>
<option value="Wyoming">Wyoming</option>
<option value="Armed Forces Americas">Armed Forces Americas</option>
<option value="Armed Forces Europe">Armed Forces Europe</option>
<option value="Armed Forces Pacific">Armed Forces Pacific</option>
</select>
<label for="input_5_7_4" id="input_5_7_4_label">State</label>
</span><span class="ginput_left address_zip ginput_address_zip" id="input_5_7_5_container">
<input type="text" name="input_7.5" id="input_5_7_5" value="" aria-required="true">
<label for="input_5_7_5" id="input_5_7_5_label">ZIP Code</label>
</span><input type="hidden" class="gform_hidden" name="input_7.6" id="input_5_7_6" value="United States">
<div class="gf_clear gf_clear_complex"></div>
</div>
</li>
<li id="field_5_8" class="gfield field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label" for="input_5_8">Phone:</label>
<div class="ginput_container ginput_container_phone"><input name="input_8" id="input_5_8" type="text" value="" class="medium" aria-invalid="false"></div>
</li>
<li id="field_5_9" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label" for="input_5_9">Email:<span class="gfield_required"><span
class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_container ginput_container_email">
<input name="input_9" id="input_5_9" type="text" value="" class="medium" aria-required="true" aria-invalid="false">
</div>
</li>
<li id="field_5_10" class="gfield gsection field_sublabel_below field_description_below gfield_visibility_visible">
<h2 class="gsection_title">Credit Card Information</h2>
</li>
<li id="field_5_11" class="gfield gfield_price gfield_price_5_ gfield_total gfield_total_5_ field_sublabel_below field_description_below gfield_visibility_visible" aria-atomic="true" aria-live="polite"><label class="gfield_label"
for="input_5_11">Total</label>
<div class="ginput_container ginput_container_total">
<span class="ginput_total ginput_total_5">$0.00</span>
<input type="hidden" name="input_11" id="input_5_11" class="gform_hidden" value="0">
</div>
</li>
<li id="field_5_12" class="gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label gfield_label_before_complex" for="input_5_12_1">Credit Card<span
class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label>
<div class="ginput_complex ginput_container ginput_container_creditcard" id="input_5_12"><span class="ginput_full" id="input_5_12_1_container">
<div class="gform_card_icon_container">
<div class="gform_card_icon gform_card_icon_amex">American Express</div>
<div class="gform_card_icon gform_card_icon_discover">Discover</div>
<div class="gform_card_icon gform_card_icon_mastercard">MasterCard</div>
<div class="gform_card_icon gform_card_icon_visa">Visa</div><span class="screen-reader-text" id="field_5_12_supported_creditcards">Supported Credit Cards: American Express, Discover, MasterCard, Visa</span>
</div>
<input type="text" name="input_12.1" id="input_5_12_1" value="" onchange="gformMatchCard("input_5_12_1");" onkeyup="gformMatchCard("input_5_12_1");" aria-required="true">
<label for="input_5_12_1" id="input_5_12_1_label">Card Number</label>
</span><span class="ginput_full ginput_cardextras" id="input_5_12_2_container">
<span class="ginput_cardinfo_left" id="input_5_12_2_cardinfo_left">
<span class="ginput_card_expiration_container ginput_card_field">
<select name="input_12.2[]" id="input_5_12_2_month" class="ginput_card_expiration ginput_card_expiration_month" aria-required="true">
<option value="">Month</option>
<option value="1">01</option>
<option value="2">02</option>
<option value="3">03</option>
<option value="4">04</option>
<option value="5">05</option>
<option value="6">06</option>
<option value="7">07</option>
<option value="8">08</option>
<option value="9">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select>
<select name="input_12.2[]" id="input_5_12_2_year" class="ginput_card_expiration ginput_card_expiration_year" aria-required="true">
<option value="">Year</option>
<option value="2021">2021</option>
<option value="2022">2022</option>
<option value="2023">2023</option>
<option value="2024">2024</option>
<option value="2025">2025</option>
<option value="2026">2026</option>
<option value="2027">2027</option>
<option value="2028">2028</option>
<option value="2029">2029</option>
<option value="2030">2030</option>
<option value="2031">2031</option>
<option value="2032">2032</option>
<option value="2033">2033</option>
<option value="2034">2034</option>
<option value="2035">2035</option>
<option value="2036">2036</option>
<option value="2037">2037</option>
<option value="2038">2038</option>
<option value="2039">2039</option>
<option value="2040">2040</option>
</select>
</span>
<label>Expiration Date</label>
</span><span class="ginput_cardinfo_right" id="input_5_12_2_cardinfo_right">
<input type="text" name="input_12.3" id="input_5_12_3" class="ginput_card_security_code" value="" aria-required="true">
<span class="ginput_card_security_code_icon"> </span>
<label for="input_5_12_3">Security Code</label>
</span>
</span><span class="ginput_full" id="input_5_12_5_container">
<input type="text" name="input_12.5" id="input_5_12_5" value="" aria-required="false">
<label for="input_5_12_5" id="input_5_12_5_label">Cardholder Name</label>
</span> </div>
</li>
<li id="field_5_13" class="gfield field_sublabel_below field_description_below gfield_visibility_visible"><label class="gfield_label" for="input_5_13">CAPTCHA</label>
<div id="input_5_13" class="ginput_container ginput_recaptcha gform-initialized" data-sitekey="6LcOfvYZAAAAAMNtp99bSD31RNXYdXcqus13aEvU" data-theme="light" data-tabindex="0" data-badge="">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LcOfvYZAAAAAMNtp99bSD31RNXYdXcqus13aEvU&co=aHR0cHM6Ly9tZXJpZGlhbmhzLm1lcmlkaWFuaHNocm1kaXJlY3QuY29tOjQ0Mw..&hl=en&v=wxAi4AKLXL2kBAvXqI4XLSWS&theme=light&size=normal&cb=2y2my8pshu8r"
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sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
</li>
</ul>
</div>
<div class="gform_footer top_label"> <input type="submit" id="gform_submit_button_5" class="gform_button button" value="Submit" onclick="if(window["gf_submitting_5"]){return false;} window["gf_submitting_5"]=true; "
onkeypress="if( event.keyCode == 13 ){ if(window["gf_submitting_5"]){return false;} window["gf_submitting_5"]=true; jQuery("#gform_5").trigger("submit",[true]); }">
<input type="hidden" class="gform_hidden" name="is_submit_5" value="1">
<input type="hidden" class="gform_hidden" name="gform_submit" value="5">
<input type="hidden" class="gform_hidden" name="gform_unique_id" value="">
<input type="hidden" class="gform_hidden" name="state_5" value="WyJbXSIsImMzZDY3NzExOTg3YzIzNDNiNWRjZGM1MjhlZGU1Nzk4Il0=">
<input type="hidden" class="gform_hidden" name="gform_target_page_number_5" id="gform_target_page_number_5" value="0">
<input type="hidden" class="gform_hidden" name="gform_source_page_number_5" id="gform_source_page_number_5" value="1">
<input type="hidden" name="gform_field_values" value="">
</div>
</form>GET https://meridianhs.meridianhshrmdirect.com/
<form role="search" method="get" class="search-form" action="https://meridianhs.meridianhshrmdirect.com/">
<div class="search-form__inner">
<label>
<span class="screen-reader-text">Search for:</span>
<input type="search" class="search-field" placeholder="Search …" value="" name="s">
</label>
<button type="submit" class="search-submit button">
<i class="fas fa-search" aria-hidden="true"></i>
<span class="screen-reader-text">Search</span>
</button>
</div>
</form>Text Content
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Meridian Health Services
240 N. Tillotson Ave., Muncie, IN 47304
Main: 866-306-2647
24 Hour Emergency: 800-333-2647
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Focusing on “Whole-Person” Healthcare
Meridian Health Services is a progressive healthcare organization that believes
in treating the “whole-person” integrating physical, mental and social
well-being to help people achieve their optimum health. This approach connects
treatments and doctors working together to heal both the body and mind for total
well-being.
Meridian Health Services primary care sites are Health Center Program grantees
under 42 U.S.C. 254b and are deemed Public Health Service employees under 42
U.S.C 233(g)-(n).
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Search for: Search
* Contact
* Locations
* Careers
* Appointments
* Donate
* Bill Pay
* Home
* ServicesServices
* Physical Health
* Primary Medical Care
* Dental Health
* Women’s Health
* Pediatric Health
* School Clinics
* Internal Medicine
* Mental Wellness
* Addictions Services
* Children & Family Programs
* Connxxions Program
* Home & School Based Programs
* Home with Hope
* Maternal Treatment Program
* Military & Veterans
* Psychiatric Services
* Skill Building
* Suicide Prevention
* Therapy & Counseling
* Women’s Recovery Home
* Social Well-Being
* Case Management
* Child Advocacy Center
* Community Resources
* Foster Hope Program
* HIV Care
* Residential & Independent Living
* Supported Employment
* Supported Housing
* For PatientsFor Patients
* Patient Info
* Health Insurance Assistance
* Patient Rights & Responsibilities
* Privacy Practices
* Support
* Visiting
* Find a Physician
* AboutAbout
* About
* Annual Reports
* Board of Directors
* History
* Brochures
* Photos & Videos
* Publications
* What Makes Us Different
* News / EventsNews / Events
* News
* Meridian in the News
* Annual Reports
* Publications
* Meridian Matters
* Photos & Videos
* Events
* Backyard BBQ
* City Fit
* Fam Fest
* Flu-Lapalooza
* Friends of Meridian Annual Golf Tournament
* Give Kids A Smile
* Holidays at Gresham
* INARF Conference
* Project Safe
* Rialzo
* Speaker Series
* Spirit of Meridian
* Suicide Prevention & Awareness Walk
* Town Hall Road Show
* Well-O-Ween
* Wellness Matters
* Featured Events
* City Fit
* Fam Fest
* Holidays at Gresham
* Project Safe
* Rialzo
* Give Kids A Smile
* Speaker Series
* Virtual Visit