Loading
Get Era/eft Enrollment Form - Apex Edi
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the ERA/EFT Enrollment Form - Apex EDI online
Filling out the ERA/EFT Enrollment Form - Apex EDI is essential for providers to manage electronic remittance advice and electronic funds transfer efficiently. This guide provides detailed, step-by-step instructions to help you navigate the online form with ease.
Follow the steps to complete the ERA/EFT Enrollment Form accurately.
- Click 'Get Form' button to obtain the form and open it in the editor.
- Begin by selecting the appropriate enrollment option: New ERA Enrollment, Change ERA Enrollment, New ERA/EFT Enrollment, or Change EFT Enrollment. Mark the checkbox next to your choice.
- Fill in the Tax Identification Number and National Provider Identification fields with the required information.
- If applicable, enter your UHIN TP# in the designated field.
- Complete the Provider Name and Provider Physical Address sections, including City, State, and Zip Code.
- Authorizations are crucial. Ensure you understand the implications of requesting electronic remittance advice and/or electronic funds transfer.
- Designate a primary contact person for ERA/EFT in the specified section. This person will be responsible for accessing files.
- If you work with a billing agent, indicate your agent's involvement by checking the appropriate box and attaching a Release Letter.
- Provide all relevant contacts that will need access to download ERA files in the ePortal ERA Contact List. Ensure to include names, email addresses, and phone numbers.
- Proceed to authorize the form. The authorized representative must print their name, sign the document, and include their title and phone number.
- Fill out the EFT Fund Information section by providing the necessary bank account details, including a voided check copy.
- The authorized signer for the bank account should print their name, sign the form, and include their title and phone number.
- After completing all sections, save your changes. You can download, print, or share the form for submission.
Ready to streamline your electronic remittance process? Complete the ERA/EFT Enrollment Form online today!
Related links form
Apex EDI is a Web-based medical claims clearinghouse that manages every aspect of the revenue cycle including claims management, eligibility and electronic remittance advice (ERAs).