Portal Administrator Application

Complete all sections. One Portal Administrator is permitted per Tax ID.

This form must be completed by the individual who will serve as the Portal Administrator for the MWG Administrators Provider Portal. The Portal Administrator is responsible for managing the account and for approving or denying all additional user requests associated with the entities listed below.

Tax ID Information

Enter the Tax ID (TIN) associated with the entities listed below. One Portal Administrator is permitted per Tax ID.

Entity Information

List the NPI for each professional group, facility, lab, and/or sole entity this Portal Administrator will manage on the Provider Portal. Individual Practitioner/Physician NPIs associated with a group are not required on this form.

Portal Administrator Contact Information
Portal Administration Agreement

Scroll through the terms below to continue

Subject to the provisions of this Agreement, MWG Administrators may allow the Portal Administrator and Authorized Users controlled access to the MWG Administrators Provider Portal (the "Portal"), including access to information regarding plan participants and their dependents, solely for legitimate healthcare operations and other lawful business purposes. Access may include member eligibility and benefits inquiries, claims status inquiries, and other functionality made available by MWG Administrators from time to time. Access shall be limited to information and plans for which the Provider and applicable user(s) have a lawful and legitimate need to access. Portal access is a privilege and not a contractual entitlement.

Definitions

For purposes of this Agreement: (a) "Provider" means the healthcare provider, facility, practice, organization, or other entity on whose behalf Portal access is requested; (b) "Portal Administrator" means the individual designated by the Provider to administer Portal access; (c) "Authorized User" means an individual approved by the Provider and granted Portal credentials; (d) "Third Party" means a billing company, clearinghouse, management company, contractor, vendor, or other entity or individual acting for or on behalf of the Provider; and (e) "Confidential Information" means all nonpublic information accessed through or relating to the Portal, including Protected Health Information ("PHI"), personally identifiable information, eligibility and benefits information, claims information, credentials, security information, and MWG Administrators' nonpublic business or technical information.

The Portal Administrator understands and acknowledges that any and all MWG Administrators data accessed through the Portal is Confidential Information. The Provider, Portal Administrator, Authorized Users, and Third Parties shall at all times preserve the confidentiality, integrity, and availability of plan participants' information and other Confidential Information. The Portal Administrator acknowledges that Portal information may include Protected Health Information ("PHI") subject to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), the Health Information Technology for Economic and Clinical Health Act (the "HITECH Act"), and the HIPAA Rules. Specifically, "HIPAA Rules" means the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Parts 160 and 164. Each party is responsible for complying with the HIPAA Rules and other applicable privacy and security laws to the extent those laws apply to that party in its applicable role. Nothing in this Agreement replaces or modifies any Business Associate Agreement or other privacy agreement required between the parties.

The Portal Administrator and Provider will require that any Third Party permitted to access the Portal, PHI, or other Confidential Information comply with privacy and security safeguard obligations at least as protective as those applicable to the Provider and comply with all applicable legal requirements. The Provider remains responsible for the acts and omissions of its Authorized Users and Third Parties relating to Portal access and Confidential Information.

Requirements of Users

The Portal Administrator agrees to be accountable for limiting access to Confidential Information to only those Authorized Users who require it based on legitimate business need and have a lawful right to access the applicable information. The Portal Administrator must approve and maintain only the minimum access reasonably necessary for each Authorized User; promptly modify or terminate access when a user's duties change, the user no longer has a business need for access, or the user separates from the Provider; periodically review user access; and ensure registration and user information remains accurate and current.

User IDs, passwords, multifactor authentication methods, security tokens, and other authentication credentials are assigned to an individual user and may not be shared, transferred, posted, or otherwise made available to another person. The Provider and Portal Administrator must use reasonable measures to prevent unauthorized credential use and comply with security requirements communicated by MWG Administrators.

The Portal Administrator agrees that access to the Portal is limited to United States Internet Protocol (IP) addresses unless MWG Administrators expressly authorizes otherwise. MWG Administrators may block foreign IP addresses and may implement or modify geolocation, multifactor authentication, password, device, session, or other security controls at any time.

Users may not access information without a legitimate permitted purpose; attempt to gain access to accounts, records, functions, or systems for which they are not authorized; circumvent or interfere with security controls; use bots, scraping tools, automated queries, or bulk extraction methods without MWG Administrators' prior written authorization; introduce malicious code; or use Portal information for any unlawful, fraudulent, competitive, or unauthorized purpose.

Security Incidents and Unauthorized Access

The Provider or Portal Administrator must notify MWG Administrators without unreasonable delay, and in no event later than twenty-four (24) hours after discovery, of any known or reasonably suspected unauthorized Portal access; disclosure or misuse of Confidential Information; loss, theft, or compromise of credentials or devices used to access the Portal; security incident affecting Portal information; or violation of this Agreement that may affect MWG Administrators, a plan, or a plan participant.

The Provider and Portal Administrator must promptly take reasonable steps to contain and mitigate the incident, preserve relevant evidence, cooperate with MWG Administrators' investigation and remediation efforts, and provide information reasonably requested by MWG Administrators.

Monitoring, Audit, and Records

MWG Administrators may monitor, log, review, and audit Portal activity, including user access, searches, downloads, changes, and other activity, for security, privacy, compliance, support, and operational purposes. The Provider and Portal Administrator must reasonably cooperate with access reviews or audits relating to Portal use and maintain records sufficient to identify Authorized Users and their access privileges.

Portal Information; No Guarantee of Coverage or Payment

Information displayed through the Portal, including eligibility, benefits, accumulators, authorizations, and claims status, is provided for informational and administrative purposes and is subject to change, applicable plan terms, exclusions, limitations, coordination of benefits, eligibility determinations, and other governing documents. Portal information is not a guarantee of coverage, benefits, eligibility, authorization, or payment. In the event of a conflict, the applicable plan document or governing agreement controls.

Suspension and Termination of Access

MWG Administrators may immediately suspend, restrict, or terminate Portal access, with or without prior notice, if MWG Administrators reasonably suspects unauthorized use, a security or privacy risk, inaccurate registration information, violation of this Agreement or applicable law, inactivity, termination of the Provider's relationship with an applicable plan, or any other circumstance in which continued access could create risk to MWG Administrators, a plan, a participant, or another person.

Indemnification

To the fullest extent permitted by law, the Portal Administrator, on behalf of the Provider, agrees to indemnify, defend, and hold harmless MWG Administrators, their affiliates and subsidiaries, and their respective directors, officers, employees, agents, and representatives from and against claims, demands, actions, liabilities, damages, losses, penalties, judgments, settlements, costs, and expenses, including reasonable attorneys' fees, arising from or relating to:

  1. Access to or use of the Portal by the Provider, Portal Administrator, Authorized Users, or Third Parties, including any negligence, gross negligence, willful misconduct, bad faith, dishonesty, fraud, or criminal conduct;
  2. Any unauthorized access, use, disclosure, alteration, or destruction of Confidential Information;
  3. Any breach of this Agreement, violation of applicable privacy, security, or other law, credential sharing, or failure to timely terminate or restrict access by the Provider, Portal Administrator, Authorized Users, or Third Parties.

All information, data, and documentation accessed by Authorized Users or Third Parties is Confidential Information. The indemnification obligations in this Section apply to acts and omissions of Authorized Users and Third Parties and survive suspension or termination of Portal access.

General Terms

This Agreement supplements, and does not replace, any other agreement between the Provider and MWG Administrators or an applicable plan. If another agreement imposes stricter privacy, security, or confidentiality obligations, the stricter obligation will apply to the extent permitted by law.

MWG Administrators may update Portal functionality, security requirements, or these Portal terms from time to time. Continued use of the Portal after updated terms are presented for acceptance constitutes acceptance of the updated terms. If any provision of this Agreement is determined to be unenforceable, the remaining provisions will remain in effect. Provisions that by their nature should survive termination, including confidentiality, security, audit, indemnification, and limitations relating to Portal information, will survive termination.

Electronic Attestation and Acceptance

By selecting "I Agree," and submitting this application, I certify and agree that I am authorized to request and administer Portal access on behalf of the Provider identified in the application and, where applicable, to accept these terms on the Provider's behalf; all information and demographic data submitted in connection with the application are true, accurate, current, and complete to the best of my knowledge; I have read, understand, and agree to comply with this Agreement; I will permit access only to Authorized Users with a legitimate business need and lawful authority; I will promptly modify or terminate access when it is no longer appropriate; I will not share credentials and will require Authorized Users to protect their credentials; and I will promptly report known or suspected unauthorized access, disclosure, credential compromise, or other security incidents as required by this Agreement. I understand that misrepresentation, unauthorized access or use, violation of this Agreement, or failure to maintain appropriate privacy and security safeguards may result in immediate denial, suspension, or termination of Portal access and any other remedies available to MWG Administrators. By selecting "I Agree," I acknowledge that my electronic acceptance is intended to constitute my electronic signature and has the same force and effect as a handwritten signature.