Enhanced Care Coordination and Collaboration

Provider Forms are available only via the Connected Senior Care Advantage Provider Portal. Access to the online provider portal is only available to providers and their staff who are contracted with Connected Senior Care Advantage. The following forms can be obtained on the Connected Senior Care Advantage Provider Portal:

Downloadable Forms

Please click here to log in to the Secure Provider Portal, if you already have a user account. If you do not yet have an account, please download and submit the Site Portal Administrator Registration Form and submit to portalenrollment@agilonhealth.com.

The Site Portal Administrator will have the ability to perform the following functions:

  • Create or disable a User Account (including any billing service you may use)
  • Change or update a User Account
  • Change or re-set an account password
  • Assign permission for each User Account
  • View and change any account under the associated entity (Tax ID)

A maximum of two (2) Site Portal Administrators are allowed per Provider or Group Practice.

Upon receipt of this form, all information will be verified and the Site Portal Administrator user account(s) will be created. The Administrator(s) will be contacted via the email(s), and be provided with a temporary password. The Site Portal Administrator will then create the User IDs for appropriate practice staff to access the Portal.

If you need assistance with completing this form, please contact your Provider Network Coordinator directly or the Provider Customer Service Line at 737-236-0999 or 833-282-8883 (toll free).