All Available Payers with Office Ally Payer List

For claim DOS on or after 9/1/22. Claims with DOS prior to 9/1/21 should be sent using payer code 74272.

For claim DOS on or after 9/1/22. Claims with DOS prior to 9/1/21 should be sent using payer code 74272.

Please contact Debra (949-635-0434) to become approved for electronic submissions.

EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: CT, DE, District of Columbia, MA, ME, MD, NH, NJ, NY, PA, RI, and VT. Effective 6/30/16 (3pm EST), Jurisdiction A will transition from NGS to CGS (Contractor Code: 16013). Office Ally will handle all updates on the back end and no submitter action is required.

EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: IL, IN, KY, MI, MN, OH, and WI. Effective 6/30/16 (3pm EST), Jurisdiction B will transition from NGS to CGS (Contractor Code: 17013). Office Ally will handle all updates on the back end and no submitter action is required.

EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: AL, AR, CO, GA, FL, LA, MS, NC, NM, OK, SC, TN, TX, VA, WV, Puerto Rico, and US Virgin Islands. Contractor Code: 18003.

EDI enrollment form under Payer Enrollment Forms - All or Multiple States. Coverage: AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, and WY. Contractor Code: 19003.

Auto Only. At this time, only Professional (HCFA) claims are accepted.

Workers Comp and Auto.

Workers Comp and Auto.

Workers Comp and Auto. At this time, only Professional (HCFA) claims are accepted.

Workers Comp and Auto.

Please Note: P5 Health Plan Solutions of Utah (87068) was taken over by Delta Health Systems and is no longer active. Providers should refer to the patient’s current healthcare ID card for the administrator of benefits and Payer ID.

Please Note: P5 Health Plan Solutions of Utah (87068) was taken over by Delta Health Systems and is no longer active. Providers should refer to the patient’s current healthcare ID card for the administrator of benefits and Payer ID.