Authorized Contacts can make changes to the account. If the Owner of the Practice/Company is not the Main Contact, we suggest that you add them as an Authorized Contact. The Main Contact above will automatically be added as an Authorized Contact.
*Please tell us how you will be submitting your claims. Check ALL that apply: (must select at least one)
*Please select your Office Ally representative. (If you do not know who your Office Ally representative is please select OTHER)
How did you hear about us? Check ALL that apply: (you must choose at least one)
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Complete the information below and an AxiaMed representative will contact you in 1-2 business days.
Currently enrolled OneHealth Port users check the box below, and fill in your OneHealth Port User Name.
*This will become your OfficeAlly User Name if available.
In order to receive your new account information quickly, please fill out and fax or e-mail back the Authorization Sheet and Business Associate Agreement
located on the screen after you click the SUBMIT button below.
Your next steps:
1. View and print the following forms:
2. Initial and sign the indicated locations
3. Fax the Authorization Sheet and Business Associate Agreement to Office Ally at (360) 314-2184
The Health Insurance Portability
and Accountability Act (HIPAA)
CAQH CORE® Certification
ONC-ACB 2014 Certified
Electronic Healthcare Network
Accreditation Commission (EHNAC)
Maryland Health Care Commission