Required Field

Registration Instructions | Registration Video

Provider NPI

Account Type

User

Administrator

Contact Information

First Name

Last Name

Job Title

Phone

Fax

User Account

Passwords must adhere to the following requirements

Must contain at least eight (8) characters.
Must contain a combination of lower case letters, upper case letters, numbers, and at least one (1) symbol.
Must not contain the user ID.
Must not contain personal information about the user that can be easily guessed such as user’s name, spouse’s name, child’s name, employee number, birth date, telephone number, city, etc.
Must not include words from an English dictionary or foreign language dictionary.
Must not contain any simple pattern of letters or numbers such as qwertyxx, 12345678, or xyz123xx.
Users are required to change their passwords every 30 days. The system will provide prompts.

Username

Password

Confirm Password

Security Question

Answer to Security Question

Please read through the Terms of Use

I agree to the Terms of Use

Terms and Conditions of Use

The materials contained in this site are private and may contain Protected Health Information. By accessing this information you will be held responsible for the use and security related to the information accessed. Any release of the information that is in violation of HIPAA regulations may result in penalties as authorized under HIPAA regulations. If you are not the intended or authorized individual, be advised that any unauthorized use, disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited.

I understand that I will also be responsible for the following:

Determine which users at my agency should have access to the ChoicePA website and grant them access to the system.
Deactivate users who no longer require access to the website for their job responsibilities or have left the agency.
Monitor website usage at the agency to maintain proper security and confidentiality measures.
Act as the point of contact at the agency for information regarding the ChoicePA website.

I understand that as a security measure, CCME may contact me on a future date to verify my position and those individuals I have registered as users under the agency’s provider number.

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