MedeWorks User Access Request Form

BlueAlliance and BlueAlliance Care + programs, Blue Cross Blue Shield of North Dakota (BCBSND) provides access to the MedeWorks Provider Dashboard.

To ensure that no Protected Health Information (PHI) is distributed to unauthorized parties, access to BCBSND tools is governed by a strict access policy. To request or update access to the BlueAlliance and/or BlueAlliance Care + Dashboards complete this form which includes the requester and the authorize access approver’s electronic signature.

This form can also be used by the authorized access approver to remove an individual’s access, if removing access, the requester signature is not required.

When the request for access has been fulfilled by BCBSND, the requester will receive two separate emails from MedeWorks.

  • One email including the URL and their username,
  • The other email containing their temporary password.

Please note, this temporary password will need to be reset within 72 hours.

For questions about this form, please email BlueAlliance@bcbsnd.com.

User Information

*Required Fields


Other User Information

*Required Fields


Requester Signature

*Required Fields


By checking this box, I acknowledge the responsibility of access to the MedeWorks Dashboard and if available to me, I accept the responsibility of ensuring the PHI data is not distributed to unauthorized parties. I understand I am creating an electronic signature that carries the same legal obligations as a written signature. I agree to all the terms and conditions set forth within this request form.

Approver Signature

*Required Fields


By checking this box, I acknowledge the responsibility of approving this individual's access and I understand I am creating an electronic signature that carries the same legal obligations as a written signature. I agree to all the terms and conditions set forth within this request form.