Accessing EIM/ESM

New Virtual Gateway Providers:

New Virtual Gateway Provider going live with contracts on EIM/ESM for the first time will be required to complete the following forms:

• Virtual Gateway Services Agreement

• Access Administrator Designation Form

• EIM/ESM Rider

• EIM/ESM User Request Form

• Organization Management Template

Existing Virtual Gateway Providers:

Existing Virtual Gateway providers going live with new contracts on EIM/ESM for the first time will be required to complete the following forms:

• Access Administrator Designation Form (only if you wish to change existing Access Administrators or add new individuals)

• EIM/ESM Rider

• EIM/ESM User Request Form

• File Transfer Service HIPAA User Request Form

• Organization Management Template - Form D

Please note:

The Virtual Gateway Services Agreement, Access Administrator Designation Form and the EIM Rider are legal documents and must be signed by a legal signing authority within your organization and the original documents mailed to the address on the form.

The EIM/ESM User request form and Organization Management Template should be completed by an Access Administrator and e-mailed to the e-mail address on the form as an Excel document.