This window allows you to register as an administrator for a billing service, provider group, or other business that is not a Medicaid Provider, Payee or Payor.
If you have previously registered as the administrator for an Other Business, and your registration is active, you will not be allowed to register again as an administrator for the same business.
If you wish to work on behalf of a payor(s), you must register as a Payor Submitter.
A Payor Submitter can only request authorization and submit on behalf of payors. A Payor Submitter cannot request authorization from a Medicaid provider, nor submit on behalf of providers.
If you want to submit on behalf of payors and providers, you will have to register your business twice in the Other Business category. Register as a Payor Submitter to work on behalf of a payor(s). Register as one of the other business types to work on behalf of a provider(s).
If you want to change your relationship with a business, review the instructions in the Change Your Business Relationship topic.
An Other Business may have no more than 2 active administrators at any one time.
Review the Business Registration Overview for more information.
You must enter all required fields, and in the correct format. See below for a list of fields and validation rules.
Field Name |
Definition |
Validation Rules |
Field Type |
|
Business Name |
the name of the business |
Required. Must be at least 3 characters in length. Certain special characters are not allowed.
|
Text Box |
|
Business Address |
the business address; should be the street address of the physical building rather than the mailing address |
Required. Address must be at least 3-characters in length. Certain special characters are not allowed. |
Text Box |
|
Second Business Address Line |
additional business address information; may be the mailing address of the business |
Not Required. If entered, the address must be at least 3-characters in length. Certain special characters are not allowed.
|
Text Box |
|
City |
the city where the business is located; must be the city where the physical building is located |
Required. City must be at least 2 characters in length. Certain special characters are not allowed. |
Text Box |
|
State |
the state where the business is located; must be the state where the physical building is located |
Required. Select an entry from the dropdown list. |
Dropdown Box |
|
ZIP |
the ZIP code of the physical building |
Required. Formats |
Text Box |
|
Business Phone Number |
the main phone number for the business |
Required. Formats |
Text Box |
|
Business Fax Number |
a fax number for the business |
Not Required. Formats |
Text Box |
|
Your Work E-Mail Address |
your work e-mail address, if you have one; or your personal e-mail address |
Required. Must be a valid e-mail format. |
Text Box |
|
Your Work Phone |
your phone number at work; if you do not have a direct line, use a phone number where you can be reached at work |
Conditionally Required if work extension is not entered. Formats |
Text Box |
|
Your Work Extension |
your phone extension number at work, if you have one |
Conditionally Required if your work phone is not entered. If entered, must be numeric.
|
Text Box |
|
Tax ID Number |
the tax ID number of the business |
Required. Formats |
Text Box |
|
Tax ID Number Type |
the type of tax ID number you entered |
Required. Select either FEIN or SSN. |
|
|
Other Business Type |
the type of business you are registering |
Required. Select an entry from the dropdown list. |
Dropdown Box |
|
Business Description |
a description of the business you are registering if you did not find a valid entry in the Other Business Type dropdown list |
Conditionally Required. If you selected Other Business from the Other Business Type dropdown list, you must enter a description of your business' type. Must be at least 3-characters in length. No special characters or numbers are allowed. |
Text Box |