Provider Registration- New Provider Packets

On Login Page, Select Provider Registration

Select Provider Type - either Employee, Independent Contractor, Agency or Participant

Input Providers Demographic Information including name, address, DOB, phone number and SSN. Then Click Next

Click Next Select which services the provider will be using. Then Click Next

Select and Print the Documents You Want – Required Forms must be printed in order to proceed

Once the Forms are Downloaded, Click Submit Please Note: Submit button will not work until you print the forms.

The Demographic Information Previously Entered Will Auto Populate in all Downloaded Forms

Registration Complete!