Self Service - Registration & Management

By completing this information, you are certifying that you work directly for the Provider and are not a third-party biller or vendor.
Please note that this process will only result in a new user being created for an existing EDISS Connect account and not the creation of a new EDISS Connect account.

Please enter the following details belonging to your account to add a new user:

Please enter a 10-digit NPI* :

Submitter ID* :

Forgot Submitter ID ? Submiter ID Lookup

TAX ID (SSN)* :

First Name* :

Last Name* :

Username* :

(Username must be unique, between 8-20 characters and contain no spaces or special characters.)

E-mail* :

Confirm Email* :

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