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The Authorized Representative (AR) Information provides a way to collect the AR’s contact information. The information requested on this page is listed in Table 1. The AR (or someone working on behalf of the AR) will be required to enter the AR’s contact information in all fields marked with an asterisk (*).
The AR is the individual in your organization (Employer/Other Plan Sponsor or Insurer/Third Party Administrator (TPA)) who has the legal authority to bind the organization to a contract and the terms of CRCP requirements. This is usually a senior executive/partner of your company/firm. The AR initiates the registration process but will not have direct access to the CRCP application and cannot be a user on the portal.
For more details regarding the AR role, see the How to Get Started help page under the How To menu.
To Complete the AR Contact Information
- Complete the following fields (Table 1). All fields marked with an asterisk (*) are required unless noted.
- Click Continue to save the information and proceed to the PIN Request Summary page, or click Cancel to display the Cancel Confirmation page.
From the Cancel Confirmation page, click Cancel to return to the Authorized Representative (AR) Information page with all information intact; or click Continue to return to the Welcome to the CRCP page with no information saved.
| Field | Format |
|---|---|
| AR First Name * | Alphabetic -- cannot contain numbers or any special characters but may contain an apostrophe (‘ ) or hyphen ( - ). |
| Middle Initial (MI) | Alphabetic. Optional. |
| Last Name * | Alphabetic -- cannot contain numbers or any special characters but may contain an apostrophe ( ‘ ) or hyphen ( - ). |
| AR Title * | Alphabetic. Optional. |
| AR E-Mail Address * | Must contain an @ sign followed by a valid extension (i.e., .org, .com, .net, etc.). See also E-Mail Note. |
| Re-Enter E-Mail Address * | Must exactly match the information entered in the AR E-Mail Address field. |
| AR Phone * + Ext: | Numeric with no spaces -- 3-digit Area Code, 3-digit Exchange, and 4-digit Suffix) plus Extension (Ext.). Ext. is optional |
| Fax | Numeric with no spaces -- 3-digit Area Code, 3-digit Exchange, and 4-digit Suffix). Optional. |
E-mail Note: The E-Mail Address provided for the AR cannot be an e-mail that is already in use either by an Account Manager (AM) or an Account Designee (AD) in the CRCP application. The e-mail must be accessible by the AR. It must be entered twice for validation.
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