An official website of the United States government
This is the second page of the Representative account registration. You must submit information for a beneficiary that will have cases submitted under this WCMSAP account.
Fields marked with an asterisk * are required.
Beneficiary Information
| Field | Description |
| Bene Last Name | Enter the beneficiary’s last name. |
| First Initial | Enter the initial of the beneficiary’s first name. |
| Bene Medicare ID | Enter the beneficiary’s Medicare ID (Health Insurance Claim Number [HICN] or Medicare Beneficiary Identifier [MBI]). The Medicare ID is also known as the Medicare Number to CMS' Medicare beneficiaries. |
| Bene Social Security Number (SSN) | Enter the beneficiary’s SSN. Required if the beneficiary’s Medicare ID is not entered. |
| Bene Date of Birth | Enter the beneficiary’s birth date, in MM/DD/YYYY form. |
| Bene Gender | Select the beneficiary’s gender from the drop-down list. |
After you have correctly entered all beneficiary information, click the Next button to proceed to the next page in the New Registration step.
Click the Previous button to return to the previous page.
Click the Cancel button to return to the WCMSAP Welcome page.
A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services.
7500 Security Boulevard, Baltimore, MD 21244