Avenda Health- Existing Account Unfold AI Reimbursement Support Program Please fill out the information below to add to your existing account. Avenda Health- Account Additions Account Information Account Name * Your Email * Which option would you like to add to your account? * Portal User Physician Facility Past Case Number Please provide the case number for a past case associated with your PRIA account. This will allow us to easily locate your existing account. Portal User Information User Contact Name * User Contact Email * User Contact Phone * Add Remove Physician Information Physician Name * Physician NPI * Physician Tax ID * Add Remove Facility Information Facility Name * Facility Address * Facility Address Facility Address Facility Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Phone Number Fax Number Facility Tax ID * Facility NPI * Add Remove Submit If you are human, leave this field blank. PROGRAM SUPPORT: MONDAY–FRIDAY 8:30AM–6:00PM EST PHONE: 860-967-0515 FAX: 860-321-1465 EMAIL: UnfoldAI@priahealthcare.com
