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Web Registration Page

Use the Web Registration page to register for Web access to the AK MMIS Health Enterprise Portal.

 

Web Registration Fields

Field Description
Medicaid ID The Alaska Medicaid provider or trading partner identification number.
SSN/Tax ID The provider's individual Social Security number or the organization's Federal Employer Identification number (FEIN). The SSN/FEIN must match what was entered on the enrollment application.

 

Organization Administrator Fields

Field Description
Provider Name The provider's name. This field is not editable and is automatically displayed based upon the provider's Medicaid ID or SSN/FEIN.
Organization Description

Short description for the organization name. This field is not editable and is automatically displayed.

Example: Primary care group for the ABC Health Care System.
Organization Name

Name of the practice or organization in which the Provider Organization Administrator resides. This field is not editable and is automatically displayed.

Example: ABC Medical Group
User ID

The organization administrator ID you want to use when logging on to the AK MMIS Health Enterprise Portal.

User IDs:

  • Are unique
  • Contain 6 to 16 alphanumeric characters
  • Contain no spaces

  • Only the following special characters can be used: hyphen (-), underscore (_), or period (.).

  • Conform to any other policies set by your organization
Prefix

The prefix of the organization administrator for your practice or organization.

Examples: Mr., Mrs.
Last Name The last name of the organization administrator for your practice or organization.
First Name The first name of the organization administrator for your practice or organization.
MI The middle initial of the organization administrator for your practice or organization.
Suffix

The suffix of the organization administrator for your practice or organization.

Examples: Sr, Jr, etc.
Phone # The phone number of the organization administrator for your practice or organization.
Ext The extension of the organization administrator for your practice or organization.
E-mail The e-mail address of the organization administrator for your practice or organization.

 

Version as of 6/30/2015.

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