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  • Electronic Funds Transfer (eft) (form 470-4202) - Iowa Department ... - Ime State Ia

Get Electronic Funds Transfer (eft) (form 470-4202) - Iowa Department ... - Ime State Ia

Iowa Department of Human Services Electronic Fund Transfer (EFT) Authorization Form This form is intended to be used by providers who would like to receive claim payments via an Electronic Funds Transfer.

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470-4202 Electronic Fund Transfer (EFT)...
470-4202 (Rev. 8/20). Electronic Fund Transfer (EFT) Authorization. This form must be...
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The Electronic Funds Transfer Authorization Form contains a form that may be used to gather information from your employees that is needed to establish an electronic funds transfer program. The file is in rich text format (RTF) that is suitable for use with most word processing programs used in the Windows environment.

Members should call Iowa Medicaid Member Services for help at 1-800-338-8366 or locally in the Des Moines area at 515-256-4606.

Medicaid is a state-federal funded program that is administered by the Department of Human Services of the State of Iowa.

Find a Provider Use the MCO's online Find a Provider Tool (linked above) Speak with your provider directly to see if they are enrolled with your MCO. Contact your MCO by phone or email (MCO contact information for members) Call Iowa Medicaid Member Services at 1-800-338-8366 or 515-256-4606.

What you need Electronic Funds Transfer Form. Providers must complete the authorized-signature (and date) field on the EFT form. ... Include the following documentation: Voided check. ... Bank letter that includes the bank name, provider name, bank account number, and routing number. ... Bank statement from the designated account.

What is that? An Automated Clearing House (ACH) authorization is a payment authorization that gives the lender permission to electronically take money from your bank, credit union, or prepaid card account when your payment is due.

Questions on Medicaid and Applying for Health Care Coverage: If you're looking for information about health care coverage options and how to apply for Medicaid, call the Department of Human Services Contact Center toll-free at 1-855-889-7985, Monday-Friday, 7:00 a.m.- 6:00 p.m.

If you would like additional information, you may contact Iowa Total Care Member Services at 833-404-1061 (TTY: 711).

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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