Get Office Ally 835 Enrollment Request 2018-2025

This guide provides clear instructions on how to complete the Office Ally 835 Enrollment Request online. By following these steps, you will ensure that your enrollment process is accurate and efficient.

Follow the steps to complete your enrollment request.

1. Click ‘Get Form’ button to access the Office Ally 835 Enrollment Request form and open it in your preferred online editor.
2. In the provider information section, fill out the provider name, address, city, state, and zip code. Ensure all information is accurate to avoid delays.
3. In the provider identifiers section, enter the federal tax identification number (EIN) followed by your national provider identifier (NPI). Double-check these values for correctness.
4. Next, provide your contact information. This includes the contact name, telephone number with extension (if applicable), email address, and fax number.
5. In the electronic remittance advice section, indicate your preference for aggregation of remittance data by selecting one option: either the provider federal tax identification number or the national provider identifier.
6. For submission details, state the reason for submission, typically 'New ERA Enrollment,' and fill in the authorized signature to confirm your submission.
7. Finally, check that all required fields marked in bold are filled out completely. Save your changes, download the form, and consider printing or sharing it as needed.

Complete your documents online today to ensure a smooth enrollment process.