Get Value Options Pre-enrollment Instructions Valop - Office Ally

This guide provides step-by-step instructions for filling out the Value Options Pre-enrollment Instructions Valop - Office Ally form online. It is designed to assist users in navigating the required fields and submitting their information accurately.

Follow the steps to complete your pre-enrollment forms effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Complete the required fields on the Online Provider Services Account Request Form. Ensure you provide accurate information such as your Provider ID, National Provider Identifier (NPI), and Tax ID.
3. Fill in your contact information, including the address, city, state, telephone number, and email address. Make sure your email is correct as important information will be sent there.
4. Select the Online Provider Services options you wish to access, including Electronic Batch Claims Submission or Individual Claims Submission. Check all that apply.
5. Indicate if you will have office staff submitting claims or if you will be using a third-party billing agent. Complete any necessary sections associated with these choices.
6. Sign the form where indicated, providing your name, title, and the date. Ensure that the person signing is authorized to do so.
7. Review the completed form for accuracy. Fax pages 1 and 2 of the completed form to 866-698-6032.
8. After submission, monitor your email for a notification from Office Ally regarding the status of your approval.

Complete your documents online efficiently today!