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Get Healthfirst Eft Enrollment 2020-2026
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How to fill out the Healthfirst EFT Enrollment online
This guide provides clear, step-by-step instructions for completing the Healthfirst EFT Enrollment form online. Ensuring accurate submission is essential for efficient processing of electronic funds transfers and electronic remittance advice.
Follow the steps to complete your Healthfirst EFT Enrollment form.
- Click ‘Get Form’ button to obtain the form and open it for editing.
- Select the type of transaction you wish to initiate by choosing one of the options: Add ERA and EFT, Change ERA, Terminate ERA and EFT, or Change EFT.
- In the provided field, print your name as the provider or physician.
- Enter your Healthfirst Provider ID number and National Provider Identifier (NPI) in the designated fields.
- Select your provider type from the options: Ancillary, Hospital, Physician, or Physician Group.
- Provide your Federal Employer Identification Number by selecting the appropriate option.
- Authorize Healthfirst by ticking the box to confirm you permit the initiation of credit entries and adjustments to the specified accounts.
- Choose your account type (Checking, Savings, Demand Deposit, Money Market) to participate in the EFT process.
- Fill in the account name, depository or bank name, address, city, state, routing number, account number, and phone number in the respective fields.
- If you wish to participate in the EFT process, attach a deposit slip or a canceled check.
- Indicate your current Clearing House if you want to participate in the ERA process and ensure you or your vendor is using one of the specified clearing houses.
- Complete the authority section, ensuring to print your name, title, provide a signature, and date the form.
- Provide contact information for a person who can verify any changes to the data listed, including their name, title, phone number, and email address.
- Once all the sections are filled out accurately, review the information, then save changes, download, print, or share the completed form as required.
Take action now by submitting your Healthfirst EFT Enrollment form online.
To get the EFT details, you can log into your Healthfirst Eft Enrollment account. Your dashboard will provide access to your account information and transaction history. Additionally, if you need assistance, you can contact customer support for further clarification. They can guide you in retrieving necessary details.
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