Select one of the following options that best describes your role.

Personal Information for Provider
Personal Information for Alternate

An individual or entity that is enrolled in the Pennsylvania Medicaid program as a provider of services.


An account created by a Provider for use by an individual within the provider's organization. Alternate accounts can be authorized by a provider to bill for more than one 13-digit MPI and Service Location.

Personal Information for Billing Agent
Personal Information for OON Provider

A third party individual or entity who is authorized to submit Medicaid transactions on behalf of a Provider.


An individual or entity that is authorized to access specific functionality within the PROMISe™ Internet Portal.