Fillable VAYA HEALTH (13010) PRE-ENROLLMENT INSTRUCTIONS (Office Ally)

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VAYA HEALTH (13010) PRE-ENROLLMENT INSTRUCTIONS (Office Ally)

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• Vaya Health Electronic Connectivity Request
• Email the form to EDI@vayahealth.com
• Standard processing time is 7-10 business days
• Office Ally should receive your approval within 7-10 business days after your enrollment has been submitted.
If you have not received the approval within 10 business days, you may contact Vaya Health at (828) 586-
5501 ext. 5227 or ext. 3313 to check the status.
• Once you receive confirmation that you have been linked to Office Ally, you MUST email
Support@officeally.com
with the below information PRIOR to submitting claims electronically.
Email Subject: Vaya Health (13010) – EDI Approval
Body of Email:
Please log my EDI approval for Vaya Health.
o Provider Name
o NPI
o Tax ID
Office Ally, Inc | PO Box 872020 | Vancouver, WA 98687 | (360) 975-7000
VAYA HEALTH (13010)
PRE-ENROLLMENT INSTRUCTIONS
WHICH FORM(S) SHOULD I DO?
WHERE SHOULD I SEND THE FORM(S)?
WHAT IS THE TURNAROUND TIME?
HOW DO I CHECK STATUS?
Vaya Health | Pre-Enrollment Instructions for Sending 837 Files MIS | Rev. 5.30.2019
Vaya Health
Pre-Enrollment Instructions for Sending 837 Files
FREQUENTLY ASKED QUESTIONS
1. How long does pre‐enrollment take?
The s
tandard processing time is seven to 10 business days
2. Where should I send the forms?
Email forms to EDI@vayahealth.com.
3. Who can sign the forms?
The provider (if a sole practitioner) may sign, as well as the president, CEO, owner, executive director, officer or managing employee of the legal entity desiring to
receive reimbursement.
4. How do I check the status of the request?
Please wait at least seven to 10 business days before contacting us for a status update. If you or your clearinghouse has not heard from us within this timeframe,
you may call 828-225-2785 ext. 3313 or ext. 5833, to request a status update.
5. How will I be notified of the decision?
• If
we cannot process your request and need more information, we will contact you via email.
• If approved, we will enter your approval into our system and notify you or your designated clearinghouse via email. After you receive this email, you or
your designated clearinghouse may begin submitting 837 files for electronic transmission.
• If you do not
receive notification from Vaya Health or from your designated clearinghouse within seven to 10 business days, contact us at one of the
extensions listed above to inquire whether you are approved or have been linked to the specified clearinghouse's submitter ID.
6. Are all cle
aringhouses eligible?
We do not pay clearinghouses for the privilege of processing your claims. For example, if you work with a clearinghouse that imposes a per-claim fee, you are
responsible for such fees. We will accept claims from any verified clearinghouse that does not charge a fee to the MCO.
Vaya Health | Pre-Enrollment Instructions for Sending 837 Files MIS | Rev. 5.30.2019
Vaya Health Electronic Connectivity Request
Please complete and submit the form below via email to EDI@vayahealth.com. NOTE: Each provider contracted with Vaya Health is required to
submit a separate connectivity request form, even if using the same clearinghouse.
Provider name National Provider ID (NPI)
Contact person Title
Mailing address
City
State
ZIP Code
Phone number Fax number Email address (required)
Estimated number of claims each month: _____________________________________
Name of vendor/clearinghouse
Contact person
Title
Mailing address
City
State
ZIP Code
Phone number Fax number Email address (required)
______________________________________________________________ _________________________________________________ ___________________________
Printed name/title (required) Authorized signature (required) Date
Office Ally
Customer Service
Customer Service
PO Box 872020
Vancouver
WA
98687
360-975-7000 Option 1
360-896-2151
support@officeally.com
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Completed 8 April 2021

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