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 A

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 V W Y

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