IDX Account Request Form

* Internal Use Only *

Managers,  if you need an IDX account created for a new employee, or want to have an existing IDX account  modified...  please completely fill out and submit the following form.  Use the "Description of Request" window for requesting account changes and providing additional information. 

Employee's Last Name:  (required)
Employee's First Name:  (required)
Employee's Middle Initial (enter "none" if no MI):  (required)

Employee's GroupWise Name: 
(Request processing will be faster if employee's GroupWise name is provided.)

Department: 
Today's Date: 
Employee's Start Date: 
 
Employee's Job Status:
Perm
Transfer
Temp
If Temp, enter Term Date: 
        
Manager's First Name:   (required)
Manager's Last Name:   (required)
Manager's Phone #:    
Explanation of Categories

UPA Standard IDX Security Categories 

DEPARTMENT                          AES               BAR               HPA        PCS

Medical Coding Analysts             CHGCLK            INQ,TESENT        CODSTAFF
Data Entry Department               CHGCLK            CHGENTRY,TESDE    CHGSTAFF
Accounts Receivable Unit (Claims)   CLMCLK            PTSERV            ARSTAFF    CLERK
Business Office (UNMH)              PCPHOSP           INQ,PTHOSP                        
Patient Services Unit (Reps)        AESPTS            PTSERV            PATSTAFF   CLERK
Patient Services Unit (Adjusters)   AESPTS            ADJSTR            PATSTAFF   CLERK
Cash Receipting Unit                AESPTS,AESRCP     RCPT              RECSTAFF   CLERK
Management Information Systems      GRP9              SYSTEM            SYSTEM     MGR
Health Information Mgmt (UNMH)                        INQ
UNMH-Operators                      OPS               OPS,TESOPS                   OPS

Please check to accept standard department access for your UPA or UNMH employee.

If UPA employee needs additional access beyond standard, check appropriate boxes below:

AESEDI EBOWO REPORTS
AESFEE EDI  
AESREJ FINANCE  
ASA INGXMGR  
CASE INQ
CHGCORR PCP  
Does your UPA employee need access to Group 4? Yes:
Does employee need access to IDX TES workfiles? Yes:
If Yes, List Required TES Workfiles:

NOTES: Manager has TES workfile information for staff.
             Press Return or Enter when you get near the right edge of the window.

UPA-Sponsored IDX Training (please check): 

StartUP
Intro PCS
Charge Entry
Reports
Payment Postings
Misc. Functions

Description of Request: (Press Return or Enter when you get near the right edge of the window.)