MIPS Participation Payment Portal

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MIPS Participation Payment Portal

Please submit payment for your OEIS NR QCDR MIPS Submission.

Please use the form below to submit your payment. If you have any questions or concerns, please contact the OEIS National Registry at [email protected]

MIPS Reporting: Payment Submission

Practice Name:*
Submission Type:*
Are you submitting for an individual physician, or a group?
- Individual
- Group
You are paying for 1 physician only.*
If you meant to pay for multiple physicians, please select "Group".
Price:
Please select the number of physicians in group:*
Total
$0.00
Submitter Name*
This is the name of the contact person we should be communicating with regarding this transaction, if needed.
First Name Middle Initial Last Name
Submitter Email:*
This is the email address of the contact person we should be communicating with regarding this transaction, if needed. A receipt will also be forwarded to this email address.
Enter Email Confirm Email
Submitter Phone:*
This is the workplace phone number of the contact person we should be communicating with regarding this transaction, if needed.
PAYMENT DETAILS
Billing Address:*
Street Address Address Line 2 City State ZIP Code
Credit Card
This field is hidden when viewing the form
Unique ID
Name
This field is for validation purposes and should be left unchanged.

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