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  • Regence Provider Eftach Form

Get Regence Provider Eftach Form

AUTOMATIC DEPOSIT (EFT/ACH CREDITS) AUTHORIZATION AGREEMENT AND CONTACT INFORMATION All fields are required Date: Provider Organization Name: Tax Identification (ID): Please set-up ALL National Provider.

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How to fill out the Regence Provider EFT/ACH Form online

Filling out the Regence Provider EFT/ACH form online is a straightforward process that ensures your payments are processed efficiently. This guide provides detailed instructions to assist you in completing each section of the form, ensuring all necessary information is provided.

Follow the steps to complete the form effectively.

  1. Press the ‘Get Form’ button to access the document and open it in your preferred editor.
  2. Begin with Section 1, where you will input your contact information. Fill in the provider organization name, date, tax identification number, and indicate any additional information needed for your EFT setup. Remember to check the box if you want to set up all National Provider Identifiers (NPI) related to the above tax ID. Complete the company street address, city, phone number, fax number, EFT contact name, email address, state, and ZIP code.
  3. Proceed to Section 2 to provide bank account information. Ensure that the account designated for EFT is a checking account, not a savings account. Fill in the depository/bank name, branch, city, state, routing/ABA number, ZIP code, and account number.
  4. Select the request type by indicating whether it is a new request or a change to an existing bank account. Attach a voided check in the designated space, ensuring the name, address, account, and routing numbers are visible. Note that bank deposit tickets, bank statements, and other forms will not be accepted.
  5. Review the authorization statement confirming your understanding of the electronic funds transfer process. Sign and date the form as required. If a co-signer is needed on the account, include their signature and date as well.
  6. Once you have filled out all sections accurately, save your changes. You can download, print, or share the form as needed before submitting it via email to eft@regence.com or FAX to 1 (888) 875-6905.

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The timely filing limit for Regence claims is generally 180 days from the date of service. This requirement aims to ensure the efficiency of claims processing and payment. Submitting the Regence Provider Eftach Form within this time frame will help you receive timely reimbursement for your services. Familiarizing yourself with this limit is beneficial for maintaining a healthy revenue cycle.

The timely filing limit for claims generally varies depending on the insurance provider. For Regence, it is essential to submit claims within a specific time frame, typically 180 days from the date of service. Knowing the timely filing limit for the Regence Provider Eftach Form helps you avoid denials and ensures prompt payment. Always keep track of your submission dates to enhance your claims process.

Another name for Blue Cross Blue Shield insurance is 'the Blues,' which is a commonly used informal term. This term encompasses various local affiliates under the Blue Cross Blue Shield Association, including Regence. Being familiar with this terminology can ease your journey through insurance processes, including the completion of the Regence Provider Eftach Form.

While Blue Cross Blue Shield and Regence are not identical, Regence acts as a regional label under the broader Blue Cross Blue Shield umbrella. Each state may have its own Blue plan, and Regence serves several states in the Pacific Northwest. This knowledge can help you understand your insurance options better, especially when completing the Regence Provider Eftach Form for efficient claims.

Regence BlueCross BlueShield of Oregon is owned by Health Solutions, a nonprofit healthcare company. focuses on transforming healthcare for individuals and families throughout the region. Understanding the ownership structure can enhance your awareness of the policies and support available, including the use of the Regence Provider Eftach Form for claims processing.

Regence is not entirely the same as Blue Shield; rather, it represents a specific regional affiliate of the Blue Cross Blue Shield Association. Regence BlueShield offers coverage in the Pacific Northwest, while Blue Shield refers to other blue health plans in the country. Understanding these distinctions can simplify your insurance navigation, especially when dealing with forms like the Regence Provider Eftach Form.

In Washington state, Blue Cross Blue Shield operates under the name Regence BlueShield. This organization provides a range of health insurance options for individuals and families. When dealing with insurance forms and claims, you may encounter the Regence Provider Eftach Form for efficient processing. It's important to familiarize yourself with this name to ensure smooth interactions with your health coverage.

Regence is part of the Blue Cross Blue Shield network but operates as a separate entity with its unique plans and policies. Both organizations share a commitment to providing quality care, though their offerings and coverage details can differ. Understanding this distinction can guide your choices when interacting with your Regence Provider Eftach Form and other documentation.

Regence offers both PPO and HMO plans, catering to various needs and preferences. A PPO generally allows more flexibility when choosing healthcare providers, while an HMO typically requires you to select a primary care physician. Understanding your options can help you select the best plan. Remember to review the specifics when completing your Regence Provider Eftach Form.

You can locate your Regence ID number on your physical insurance card. If you do not have your card, you can access your online account to view your policy information. Alternatively, you can contact Regence customer service for assistance. Ensure you have your Regence Provider Eftach Form ready for any queries.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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