Electronic Data Interchange (EDI) Enrollment (8292 form) - Office Ally-2026

1. Click ‘Get Form’ to open the Electronic Data Interchange (EDI) Enrollment (8292 form) in the editor.
2. In Part A, select all applicable contracts for your Medicare billing. Ensure you check the boxes that correspond to your services.
3. In Part B, enter the name of your group, physician, provider, or supplier. This must match the name on file with Medicare as per the CMS-855 Enrollment form.
4. Fill in your practice location details in Section C, including street address, city, state, and zip code. Ensure these match what is recorded with Medicare.
5. Provide contact information including a contact person’s name, telephone number, fax number, and email address for enrollment responses.
6. Complete Section D by entering your NPI and PTAN numbers. These must align with Medicare records.
7. In Section E, specify who will prepare and submit electronic claims. If using PC-ACE Pro32 software, check the appropriate box.
8. Review Sections F through I for any additional requests regarding submitter IDs or electronic remittance advice options before signing.

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