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Health PAS-OnLine Registration

  • Step:Demographic Information
    * Indicates required field.
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    select
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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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    select

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    select

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    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.
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  • Step:Security Information
    * Indicates required field.
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    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.
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    Please enter a confidential question and answer
    for password reset and user name recovery purposes.
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  • 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. ({0} {1}) Date :
    Host Name : ec2-3-209-80-87 IP Address : 3.209.80.87