An official website of the United States government
This page is used to capture information for the Account Designee. All fields are required except the MI (Middle Initial), phone extension, Address line 2, and ZIP+4 field. For more information on the Account Designee role, see the How to Get Started on the Medicare Secondary Payer Recovery Portal help page.
Account Designee Information | |
|---|---|
| Field | Description |
| First Name | Given or first name of Account Designee. |
| MI | First letter of Account Designee's middle name. Note: This field is not required. |
| Last Name | Surname of Account Designee. |
| E-mail Address | Account Designee e-mail address. |
| Re-enter E-mail Address | Second entry of the Account Designee e-mail address for verification purposes. This information cannot be cut and pasted. |
| Phone | Account Designee phone number. |
| Ext | Account Designee extension. Note: This field is not required. |
| Address Line 1 | First line of the Account Designee mailing address. Street number and street name should be placed on one address line field while other information such as suite number, attention to, etc. should be placed on the other. |
| Address Line 2 | Second line of the Account Designee mailing address. Street number and street name should be placed on one address line field while other information such as suite number, attention to, etc. should be placed on the other. Note: This field is not required. |
| City | Account Designee mailing address city. |
| State | Account Designee mailing address state. This is selected from a drop-down list box. |
| Zip | Account Designee 5-digit Zip Code and the 4-digit Zip+4. Note: The ZIP+4 field is not required. |
Click [Previous] to return to the previous page (Designee Registration).
Click [Continue] to proceed to the next page in the Registration process. The Designee Login Information page will display.
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