Get (eft) Form - Uhccommunityplan.com

Completing the Electronic Payments and Statements (EPS) enrollment form is a crucial step towards managing your payments electronically. This guide will provide you with comprehensive, step-by-step instructions on how to accurately fill out the (EFT) Form - UHCCommunityPlan.com online.

Follow the steps to complete your enrollment form successfully.

1. Press the ‘Get Form’ button to access the enrollment form and open it in your online document manager.
2. Select your enrollment type by checking one of the boxes: 'New Enrollment' or 'Changes to Existing Enrollment'.
3. Complete Section I with required organization information, including your organization name, tax ID number, address, city, state, and ZIP code, as well as primary and secondary contact information.
4. In the Designation of Depository section, fill in your business checking account information including bank name, checking account number, bank address, routing transit number, and phone number.
5. Attach a voided check or a bank letter to your form to ensure accurate processing.
6. Sign and date the authorization section, ensuring that the printed name and title of the authorized individual are entered.
7. Proceed to Section II and select your preferred remittance options. Provide the necessary information as prompted.
8. Complete Section III by adding individuals who should receive deposit notifications via email, including their names and email addresses.
9. Review all provided information for accuracy. Save any changes made before proceeding.
10. Download or print the completed form for your records. You can share the form via fax or mail to the provided address.

Complete your (EFT) Form - UHCCommunityPlan.com online today for seamless electronic payments and statements.