An official website of the United States government
This page asks you to enter your personal information.
It is critical that the person completing this step is the Account Manager for the WCMSAP Account and provides their specific, personal information.
You may not change your Account Manager online after the Account Setup has been processed. If you need to make a change later, you will have to contact the BCRC EDI Department.
All fields required unless indicated.
| Field | Description |
|---|---|
| Same as Submitter | This button is only shown for Representative account types. If the button is clicked, the fields below are populated with the Representative Information entered during the New Registration process. |
| First Name | Enter your first name. |
| MI | Enter your middle initial. Optional. |
| Last Name | Enter your last name. |
| E-mail Address | This field is pre-populated with the email address you previously provided in the Account Setup process. |
| Phone | Enter your company or work telephone number. The extension field is optional. |
| Address Line 1 | Enter the first line of your mailing address. |
| Address Line 2 | Enter the second line of your mailing address. Optional. |
| City | Enter your city. |
| State | Select your state from the drop-down list. |
| Zip Code | Enter your ZIP code. The ZIP+4 field is optional. |
| User Agreement and Privacy Policy | You must read the User Agreement and Privacy Policy provided in the scroll box. Use the scroll bar at the right to scroll through the entire User Agreement and Privacy Policy. Alternately, click the View and print the User Agreement and Privacy Policy below link to view the agreement in a separate window. To accept the agreement, click the checkbox on the Account Manager Personal Information page. You must accept and agree to the terms of the User Agreement and Privacy Policy to continue. |
If you have correctly entered all your personal information as the Account Manager, click the Next button to proceed to the next page in the Account Setup process.
Click the Previous button to return to the previous page.
January 2025
A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services.
7500 Security Boulevard, Baltimore, MD 21244