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Health PAS-OnLine

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 Health PAS-OnLine Registration
  • Step:Demographic Information
    • * Indicates required field.
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      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.
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      Enter the following credentials for any of your billing provider 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 Medicaid Provider 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.
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  • Step:Security Information
    • * Indicates required field.
      * :
      Password must contain at least 6 characters consisting of an upper and lower case letter, a special character such as a # or * or ^ (except ,) and a number.
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      Please enter a confidential question and answer
      for password reset and user name recovery purposes.
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  • Step:MaineCare : Electronic Remittance Advice Information
    • ERA Authorization Help
      Provider Information
      Provider Name :
      Doing Business As Name (DBA) :
      Provider Address
      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 :
      Electronic Remittance Advice Information
      * :
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      (e.g., Account Number Linkage to Provider Identifier)
      Method of Retrieval : Download PDF
      Download 835 No 835
      Third Party *   
      Submission Information
      Reason for Submission :
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      Authorized Signature :
      * :
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      RadDatePicker
      RadDatePicker
      Open the calendar popup.
  • Step:Confirm Information
  • Step:Agreement
    • Yes, I agree to the above terms and conditions. Print
      * : Please enter the same First Name and Last Name as entered in Demographics Information. Date :
      Host Name : 10 IP Address : 10.129.222.32