User Details

Register As

Name

First Name

MI

Last Name

Title

Date of Birth

Company Name

Address Line 1

Address Line 2

Zip Code

ZIP code must be in xxxxx or xxxxx-xxxx for USA and AXA XAX for Canada. Where A is any uppercase alphabetic character and X is a numeric digit from 0 to 9.

City

State/Province

Country

Phone

Website

Tax ID

Do You Require VMS Access?

Request association to specific provider?

Enter the following credentials for any of your provider billing records. If you have more than one billing provider record, you may add the additional provider records to your online account after registration. Enter values for FEIN/SSN; either NPI or Atypical ID; and PIN. For providers, these values are your tax ID, NPI or API, and PIN. For Billing Agents, these values are for a provider for whom you intend to submit transactions.

Enter the fields below using the information found on your Medicaid card. If you are registering as a Guardian, please enter your information here. Any wards under your guardianship will be available once you are logged into your account. Refer to the user guide if additional assistance is needed.

FEIN/SSN

Member PIN (Last 4 digits of Medicaid ID)

NPI

Member ID

Atypical ID

* User Name

* Password

Password must contain at least 8 characters consisting of an upper and lower case letter, a special character such as a # or * or ^ (except ,) and a number.

* Re-enter Password

* Email

* Re-enter Email Address

* Security Question

* Security Answer

PROVIDER INFORMATION

Provider Name

Doing Business as Name (DBA)

Street

City

State/Province

Zip Code /Postal Code

Country Code

PROVIDER IDENTIFIERS

Provider Federal Tax Identification Number (TIN) or Employee Identification Number (EIN)

National Provider Identifier (NPI)

Other Identifier(s)

Assigning Authority Authority

PROVIDER AGENT INFORMATION

Provider Agent Name

Telephone Number

Email Address

Street

Provider Agent Contact Name

City

State/Province

Zip Code /Postal Code

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ELECTRONIC REMITTANCE ADVICE INFORMATION

*Preference for Aggregation of Remittance Data

Method of Retrieval (Optional)

SUBMISSION INFORMATION

*Reason for Submission

Authorized Signature

*Electronic Signature of Person Submitting Enrollment

*Requested ERA Effective Date

Name test

DOB test

Company Name test

Address test

City test

State/Province test

Zip Code test

Country test

Phone test

User Name test

Email test

Security Question test

Security Answer test

Yes, I agree to the above terms and conditions.

Signature

Date 4/7/2026 10:02:50 AM

Host Name sts.medicaid.dc.gov

IP Address 10.112.199.99