Fillable BCBS OF MASSACHUSETTS (BS059) PRE-ENROLLMENT INSTRUCTIONS (Office Ally)

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BCBS OF MASSACHUSETTS (BS059) PRE-ENROLLMENT INSTRUCTIONS (Office Ally)

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• Blue Cross Blue Shield of Massachusetts Enrollment Form
• Email the form to Support@officeally.com
o Subject should contain: BCBS MA Enrollment
• Standard processing time for EDI enrollment is 2-3 business days.
• The time it takes ERAs to start coming through is dependent upon the payer. Generally, ERAs can
take anywhere from 10 to 45 business days to begin coming through.
• Once your enrollment has been processed you will receive an email from Office Ally indicating that
you can begin submitting claims electronically.
Office Ally, Inc | PO Box 872020 | Vancouver, WA 98687 | (360) 975-7000
BCBS OF MASSACHUSETTS (BS059)
PRE-ENROLLMENT INSTRUCTIONS
WHAT FORM(S) SHOULD I DO?
WHERE SHOULD I SEND THE FORM(S)?
WHAT IS THE TURNAROUND TIME FOR ERA ENROLLMENT?
HOW DO I CHECK STATUS?
In order to enroll to receive ERAs electronically from this payer, please fill out this form and return it via email
to Support@officeally.com, the Email Subject should read: BCBS MA Enrollment.
Provider Name:
Provider Address:
Provider Federal Tax Identification Number (TIN)
OR Employer Identification Number (EIN):
National Provider Identifier (NPI):
Provider Contact Name:
Telephone Number:
Email Address:
Preference for Aggregation
Of Remittance Data:
Note: Per BCBS MA, NPI is always used.
Reason for Submission:
Authorized Signature:
Note: Electronic Signature (typed name) of Person Submitting ERA Enrollment.
Office Ally, Inc | PO Box 872020 | Vancouver, WA 98687 | (360) 975-7000
BCBS OF MASSACHUSETTS
ENROLLMENT FORM
PROVIDER INFORMATION:
PROVIDER IDENTIFIERS INFORMATION:
PROVIDER CONTACT INFORMATION:
ELECTRONIC REMITTANCE ADVICE INFORMATION:
SUBMISSION INFORMATION:
Select One
National Provider Identifier (NPI)
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BCBS OF MASSACHUSETTS (BS059) PRE-ENROLLMENT INSTRUCTIONS (Office Ally)

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Completed 8 April 2021

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