Get 835 Transactions - Era Enrollment Form Through Office Ally

This guide provides clear, step-by-step instructions on completing the 835 Transactions - ERA Enrollment Form through Office Ally. Whether you are new to digital document management or are familiar with enrollment forms, this resource will help you navigate each section with ease.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your editing tool.
2. Fill in the provider information section. Start with the provider name and address, including the city, state, and zip code.
3. Complete the provider identifiers information. Enter the provider federal tax identification number, national provider identifier (NPI), and employer identification number (EIN).
4. Provide the provider contact information by entering the contact name, telephone number/extension, email address, and fax number.
5. In the electronic remittance advice information section, indicate your preference for aggregation of remittance data by choosing either the provider federal tax identification number or national provider identifier. Remember to only select one option.
6. State the reason for submission, selecting 'New ERA Enrollment' to indicate the purpose of filling out the form.
7. Sign the form by typing the authorized signature of the person submitting the ERA enrollment.
8. Once you have completed all fields, review the form for accuracy, save your changes, and then download, print, or share the completed form as needed.

Ensure your enrollment is processed efficiently by completing the 835 Transactions - ERA Enrollment Form online.