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Tuesday, May 21, 2024
Provider Registration *=Required
Enter your Provider Identification, User Access information and click Continue to begin the online
registration process.
Provider Identification
*FIS Provider ID:
*Provider Phone # : - -
*State or Program:
*Last 4 digits of Provider's Bank Account # : Help?      
Only used in adding an additional User ID and will gray out after choosing a
"Program" in the above drop-down box.
User Access
*User ID:
(User ID must be an email address;
sample: John_Doe@provider.com)
*Re-enter User ID:
*Password:
(Passwords must be between 8 and 14 characters long and must contain at least 1 number,
1 lower case letter and 1 upper case letter, with no special characters.
The password may also have up to a maximum of 3 repeating characters.)
*Confirm Password:
*Challenge Question 1:
*Challenge Response 1:
*Challenge Question 2:
*Challenge Response 2:
*Challenge Question 3:
*Challenge Response 3:
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* Enter the text shown above :
  
Note: If you have questions or experience problems with the registration process, call null
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