Are you sure you want to logout?
If you navigate away from this page, you will lose unsaved data. Are you sure you want to logout?
Thursday 06/04/2020 10:32 PM EST
Registration Step 1 of 2 - Personal Information
Indicates a required field.
This section is not required for Billing Agents. NPI must be entered for all healthcare providers (taxonomy is optional). If you do not qualify for an NPI, please provide your Medicaid Provider Number.
Please provide the following information to get started.
Trading Partner ID
Trading Partner Full Name
FEIN (Tax ID)
MA Provider #
© 2020 DXC Technology Company. All rights reserved. |