Attention: Providers without an approved enrollment application will be unable to register for a Provider Web Portal account. To begin an enrollment application click the Home link above then click the Provider Enrollment icon.

Registration

Select one of the following options that best describes your role.


Personal Information for Provider
An individual, state or local agency, corporate, or business entity that is enrolled in the Healthcare program as a provider of services.
Personal Information for Delegate
An individual designated by an organization for the sole purpose of performing clerical functions and is responsible for ensuring patient privacy information accessed via this website is to be used only for legitimate business reasons.
Personal Information for Billing Agent
An individual, state or local agency, corporate, or business entity that is enrolled in the Healthcare program as a billing agent for services.
Personal Information for Case Manager
An individual that helps provide an array of services to help individuals and families cope with complicated situations in the most effective way possible, thereby achieving a better quality of life. They help people to identify their goals, needs, and resources.
Personal Information for Managed Care
A Managed Care Entity (MCE), Administrative Service Organization (ASO) or Behavioral Health Administration (BHA) authorized to provide services and/or perform administrative services as designated by the state.
 R05.00.364