Remittance Delivery: Delivery pathway is going to vary and will require clearinghouse level enrollment, please contact us for help if you have trouble getting it working!
Enrollment Instructions:
Please complete the ERA Transfer letter in addition to enrollment forms required as per the Enrollment instructions.
ERA Transfer Letter: https://apps.availity.com/availity/documents/Office_Ally_ERA_Transfer_Letter_835.pdf
ERA Enrollment Instructions: https://cms.officeally.com/OfficeAlly/Forms/ERA/HealthPlanSanMateo_EFT_ERA_ENR_Instructions.pdf
Please complete the ERA Transfer letter in addition to enrollment forms required as per the Enrollment instructions.
ERA Transfer Letter: https://apps.availity.com/availity/documents/Office_Ally_ERA_Transfer_Letter_835.pdf
ERA Enrollment Instructions: https://cms.officeally.com/OfficeAlly/Forms/ERA/HealthPlanSanMateo_EFT_ERA_ENR_Instructions.pdf
Additional Instructions:
HPSM1.HEALTH PLAN SAN MATEO.835.032025.pdf
HPSM1.HEALTH PLAN SAN MATEO.835.032025.pdf