PCORI Fee Reporting Services for Current BPC Clients

Thank you for your interest in BPC's PCORI Fee Reporting Services. Please complete the form below and your BPC Benefit Specialist will contact you to complete your report. 

Upon completion of your report, you will be charged $175.00 on your next monthly invoice. Please read the Provider Service Agreement for PCORI Fee Reporting and Compliance. You will be asked to confirm your acceptance below.

Are you a current BPC client? *
Contact Name *
Contact Name
Phone *
Phone
Please place your initials in the box below to acknowledge that you have read and accept the Provider Agreement for PCORI Fee Reporting and Compliance that is linked above this form.

Please read the Provider Service Agreement for PCORI Fee Reporting and Compliance.