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In accordance with the CMS security policy, the FISS Logon ID is not to be used by any one other than the assigned user. Highmark Medicare Services requires that every user of a FISS/HIQA Logon ID must have a unique Logon ID for greater accountability and security. The password is not to be revealed to anyone, including supervisors and managers.

It is critical that all logon requests submitted to Highmark Medicare Services have the REQUESTOR’S individual e-mail address and telephone number on the request form or change form. Logon information will no longer be sent to the managers, supervisors or persons other than the REQUESTOR. The requestor, and ONLY the requestor, will now receive the logon information directly.


Do You Currently Have an active RACF ID?
Yes No
Requestor's Information

Name Logon ID is being requested for (Requestor): Enter First Name, Middle Initial and Last Name

Job Title of Requestor:

Requestor's Telephone Number:

Requestor's Email Address (Required):

Supervisor's Full Name:

Supervisor's Phone Number:

Type of Access: Select one of both

 

FISS HIQA

PIN (4-DIGIT Numeric, Required - Enter a 4 digit number you will remember, you will need this number in order to have your password reset. We suggest using the last 4 digits of your SSN.) :


Logon Information

Provider Number(s) to be accessed by this Logon ID:
 

Business Purpose for Accessing the Medicare System (Required): i.e. what type of transactions will be performed
 


Provider Information

Provider Name:

Provider Address:
 


By submitting this form you are agreeing to the following:

  • I understand the responsibility to protect and maintain the confidentiality of the data.
  • I also understand that if the Medicare data obtained from the FISS is mishandled in any way,I will be held responsible in accordance with Medicare requirements.

I have read the above agreement and attest to the truth of all information submitted herein.

    
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