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Payer EDI Enrollment Forms

Some payers require pre-enrollment before permitting the provider to submit electronic claims to them. Typically payers such as Medicare, Medicaid, Blue Cross, and Blue Shield require pre-enrollment. Payers that require pre-enrollment are indicated on our Payer Lists (ENR column). As a service to our customers, Office Ally provides these agreements and forms below, pre-filled with Office Ally’s information where ever required. Below is a list of all Pre-Enrollment forms available (sorted by state).

Be sure to complete the form(s) as indicated on the Instructions Cover Page to ensure applications are not denied.

Payer Enrollment Forms (by State):

Click here to view Electronic Remittance (ERA/835) Enrollment Forms

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