Submit a Lead

Use the Agent Code or Business ID provided by the agent.

Agent Code

Provided by the agent or their manager.

Why this matters: Every lead you submit is permanently attributed to your marketing team. Using the correct Agent Code ensures your leads are tracked in your dashboard.

⚠ Important: Leads submitted without a verified Agent ID or Business ID cannot be tracked in your dashboard. This system ensures every lead you submit is always attributed to your marketing team.

⚠️

Invalid Code

Select the agent you are submitting this lead for:

Submitting lead to:

Fields marked * are required.

Full Name *

Phone Number *

Required if no email provided.

Email Address

Date of Birth *

Medicare Beneficiary ID (MBI)

Medicare Effective Date

Medicaid Status

Street Address

City

State

ZIP

Preferred Contact Time

Estimated Annual Income

Your Name (Rep)

Notes for Agent

✅

Lead Submitted!

The agent has been notified and will follow up with this prospect shortly.

📞

Lead Submitted!

Transfer the call now — the agent has already been notified.

Transfer call to

The agent received a push notification that this call is coming. Their caller ID will show the lead's number.

Submit a Lead

Invalid Code

Submitting lead to:

Live Call Transfer

Lead Submitted!

Lead Submitted!