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Provider Registration- New Provider Packets
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On Login Page, Select Provider Registration
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Select Provider Type - either Employee, Independent Contractor, Agency or Participant
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Input Providers Demographic Information including name, address, DOB, phone number and SSN. Then Click Next
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Click Next Select which services the provider will be using. Then Click Next
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Select and Print the Documents You Want – Required Forms must be printed in order to proceed
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Once the Forms are Downloaded, Click Submit
Please Note: Submit button will not work until you print the forms.
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The Demographic Information Previously Entered Will Auto Populate in all Downloaded Forms
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Registration Complete!
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