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  • Unicare Eft Enrollment Form

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L be returned unprocessed. Please print clearly. A separate form is required for each Tax Identification Number. INSTITUTIONAL PROFESSIONAL DENTAL Provider Name: Location code If Applicable Tax ID #: NPI #: Medicare #: Institutional Providers Only Street Address: City: State: ZIP:.

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The electronic Payor ID number for the UniCare State Indemnity Plan is 80314.

The FEIN is a unique nine-digit corporate ID number that works the same way a Social Security number does for individuals. The tax number for individuals, also referred to as a tax identification number or TIN, is an individual's Social Security number.

With Electronic Funds Transfer (EFT), Medicare can send payments directly to a provider's financial institution whether claims are filed electronically or on paper. All Medicare providers may apply for EFT.

UniCare IndustryHealth insuranceHeadquartersIndianapolis, Indiana , United StatesOwnerElevance HealthWebsitewww.unicare.com

How can I enroll in the EFT? Electronic Enrollment: To enroll in EFT, providers can access the electronic enrollment application found on the PROMISeâ„¢ Provider Portal. This is a quick, easy, and secure way to enroll for EFT payment.

A. Yes. The unique prefixes (20, 26, 27, 45, 46, 47, 81, 82, 83, 84, 85, 86, 87, or 88) identify the EIN as a number issued via the internet. Note: We cannot process your application online if the responsible party is an entity with an EIN previously obtained through the Internet.

The electronic Payor ID number for UniCare is 80314.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232