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835 ENROLLMENT REQUEST - cms officeally

835 ENROLLMENT REQUEST - cms officeally 2025

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The document is an enrollment request form for Office Ally, intended for providers to enroll in Electronic Remittance Advice (ERA) services. It includes sections for provider information, identifiers, contact details, and submission instructions. Providers must complete the form legibly and entirely to avoid delays in processing. The document also lists various payers for which enrollment can be requested.

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2020	4.5 Satisfied (21 Votes)
2018	4.3 Satisfied (36 Votes)
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