Understanding Our Client's Needs
Delivering Quality Services
Independent Service Provider

Sign Up to Receive Referrals from UDI

Glass Referrals
UDI has a number of different Glass Referral programs with a number of different partners. In some cases, you will bill UDI's client directly through UDI; in other cases we will simply provide you with a hot referral. In this case you take responsibility of all billing including coverage verification. For the programs where you bill UDI directly, we will provide payment within three weeks.
However, none of the programs work without your participation. The documents below need to be printed, filled out, and faxed to UDI in order to qualify to receive referrals in our programs. Please note that each document has a unique fax number.

Convenient Automatic Electronic Transfer
In order to receive referrals from UDI, you will need to setup one of two Electronic Payment Plans with UDI. The preferred plan is an ACH Agreement that allows UDI to send or receive money from your bank account directly. The other plan is a Credit Card Authorization Agreement. Please choose the Electronic Payment Plan that best fits your needs and comfort.

ACH forms
The advantage for you in using an ACH Agreement Plan is that when you bill us directly we can pay you much faster, directly to your bank account. We have more than one ACH Agreement because some of our programs have different payment requirements. Please print and fill out both ACH Authorization forms below.

Please Note: Some providers have indicated a concern about setting up ACH Agreements into their bank accounts. We value the providers that are part of our referral program and take all of their concerns seriously. We have addressed this concern in two ways. First, we always send an email notice one day before any monies are credited or debited. Secondly, we strongly recommended that you setup separate bank accounts to manage your ACH Agreements.

One more Important Note: If funds are not available the next day for the amount indicated on the invoice, there will be a $25.00 NSF Fee.  Please be sure there is a limited amount to prevent this extra cost to you.

Credit Card Authorization
There is no advantage in using a Credit Card Plan over the ACH Plan. It is provided for those who feel more comfortable with this method.

The disadvantage with this plan, is that UDI can only send your payments via check in the US Mail. It will take longer for you to receive your money. Some people feel they have more control with a Credit Card, but if you manage your ACH Plans as explained above, you have all the control you will need. Please print and fill out the Credit Card Authorization form below.

Service Provider Information Form
We may already have you in our system, but even so, we would like to make sure we have the most accurate information about you and your services. Please fill out and fax to UDI the UDI Provider Information Form below.
Provider Information FormProvider Information Form