PHPMCS EDI Transaction Portal
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 USER SELF-REGISTRATION

 Please complete all requested information.

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  1)   SELECT REGISTRATION TYPE:  


  2)   PROVIDER REGISTRATION
Email

PLEASE ENTER THE TAX #'s (EIN's) FOR REQUESTED ACCESS (comma-delimited):


SELECT THE ORGANIZATIONS - TAX# - NPI BELOW FOR REQUESTED ACCESS:
  2)   MEMBER REGISTRATION
Email
Member ID
DOB (mm/dd/yyyy)
Zip Code
  3)   PERSONAL INFORMATION
Last: (Required)
First: (Required)
Middle:
Address:
City:
State:
Zip Code:
Phone:
Fax:

  4)   LOGIN SETTINGS
Username   Use Email Password Password Strength Confirm Password
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PRIVACY STATEMENT  
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