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 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 Clerk
An individual designated by the Provider or Billing Agent 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.
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