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Request Form for Provider MCIS and LON Access


Wednesday, June 6, 2018

In order to access MCIS, each person within a Provider organization must have a unique individual MCIS username and password account.  There is no sharing of this information between staff members within or across any organization.   All requests for MCIS access must be submitted to the Office of Information and Data Management (OIDM) via email to [email protected] using the attached updated document link below to add, update or remove a MCIS user’s account.

Current MCIS Provider’s account users can submit their access request immediately.  New MCIS Provider’s account users must wait until they have completed all of the required prerequisites of a new Provider and received approval from the Provider Relations Specialist before they can submit an MCIS access request.

Providers should complete the bolded areas of their PDF memo by typing in the information being requested and printing it onto their agency’s letterhead along with the appropriate agency’s official, title, phone number, email address and  signature (Presidents, Directors, CEO’s COO’s or Agency Heads) then email this MCIS access request letter back to DDS IT attention. Each individual will receive an email with their MCIS access account information and instructions.

The processing of your request can take between 3-5 business days depending upon the number of other requests that have been received prior to your submission.  Thirty days of non-use or inactivity will automatically disabled a user’s account and another request for MCIS access will have to be resubmitted by your organization’s official.  It is each user’s responsibility to reset their passwords every thirty (30) days. Personal emails and duplicate accounts are not acceptable due to security protocols and possible HIPPA violations.