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Electronic Remittance / ERA / 835 Enrollment Forms

Some payers require pre-enrollment in order to activate Electronic Remittance Advice (ERA/835). Payers that require pre-enrollment for ERA are indicated on our Payer Lists. As a service to our customers, Office Ally provides these forms below, pre-filled with Office Ally’s information where ever required. Below is a list of all electronic remittance advice (ERA/835) forms available (sorted alphabetically).

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


Payer ERA Enrollment Forms (A-Z)

Click here to view Non-ERA Payer Enrollment Forms
#1-9
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B
 
C
 
D
E
 
 
F

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G
 
 
H
I
J
K
L
M
 
 
N
 
 
O

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P
Q
R
S
T
 
 
U
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Advanced Tips
Type Example Notes
Fuzzy kettle~ Contain terms that are close to the word kettle, such as cattle
Wild cat* Contain terms that begin with cat, such as category and the extact term cat itself
Exact-Single orange Contain the term orange
Exact-Phrase "dnn is awesome" Contain the exact phase dnn is awesome
OR orange bike Contain the term orange or bike, or both. OR, if used, must be in uppercase
orange OR bike
AND orange AND bike Contain both orange and bike. AND must be in uppercase
Combo (agile OR extreme) AND methodology Contain methodology and must also contain agile and/or extreme
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