Office Ally 835 Enrollment Request 2018 free printable template

835 ENROLLMENT REQUEST Email this form to enrollment admin×officeally.com or Fax to (360) 3142184. Once your form is received and processed Office Ally will email or call you. If you do not receive

How to fill out 835 enrollment request

How to fill out Office Ally 835 Enrollment Request

1. Start by downloading the Office Ally 835 Enrollment Request form from the Office Ally website.
2. Fill in your practice name and address in the designated fields.
3. Provide your National Provider Identifier (NPI) number.
4. Enter your Tax Identification Number (TIN).
5. Indicate the type of account you are enrolling for by checking the appropriate box.
6. Include your contact information, including email and phone number.
7. Review the form for any errors or omissions.
8. Sign and date the form where indicated.
9. Submit the completed form as instructed, either by mail or electronically.

Who needs Office Ally 835 Enrollment Request?

1. Healthcare providers who wish to receive electronic remittance advice (ERA) payments.
2. Billing and coding professionals working on behalf of healthcare providers.
3. Any organization requiring electronic processing for insurance claims and payments.

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What is Office Ally 835 Enrollment Request?

The Office Ally 835 Enrollment Request is a form used by healthcare providers to enroll in the Office Ally Electronic Remittance Advice (ERA) system, which allows for the electronic viewing and management of payment information.

Who is required to file Office Ally 835 Enrollment Request?

Healthcare providers, including physicians, clinics, and hospitals, who want to receive electronic remittance advices from insurance payers through Office Ally are required to file the 835 Enrollment Request.

How to fill out Office Ally 835 Enrollment Request?

To fill out the Office Ally 835 Enrollment Request, providers need to enter their organization details, including the National Provider Identifier (NPI), tax identification number, contact information, and any specific payer information required for the ERA setup.

What is the purpose of Office Ally 835 Enrollment Request?

The purpose of the Office Ally 835 Enrollment Request is to facilitate the setup of electronic remittance advice services, enabling providers to streamline their revenue cycle processes by receiving payments and explanations electronically.

What information must be reported on Office Ally 835 Enrollment Request?

The information that must be reported on the Office Ally 835 Enrollment Request includes the provider's NPI, EIN, practice name, contact details, payer names, and any relevant enrollment details needed to establish electronic remittance advice delivery.