Get Coventry Eft Enrollment Form - Healthcare Automations - Healthcareautomations

This guide provides clear, step-by-step instructions on how to properly fill out the Coventry EFT Enrollment Form. By following these instructions, you will ensure a smooth enrollment process for the Electronic Funds Transfer (EFT), allowing you to receive payments more efficiently.

Follow the steps to complete your EFT enrollment form effectively.

1. Press the ‘Get Form’ button to obtain the Coventry EFT Enrollment Form and open it in your preferred document editor.
2. Complete the provider information section. Fill in the required fields such as provider name, address, and contact information. Ensure that all information is accurate and legible.
3. Fill in the provider identifiers section. Enter the provider's Federal Tax Identification Number (TIN) or Employer Identification Number (EIN) and National Provider Identification Number (NPI). Ensure these numbers are correct as they are crucial for processing.
4. In the financial institution information section, provide details about your bank, including the financial institution name, address, routing number, and type of account (checking or savings). Make sure to check the account number for accuracy.
5. Select the account number linkage method, either by Provider Tax Identification (TIN) or National Provider Identification (NPI). If you opt for NPI, list any additional NPIs you wish to enroll for EFT payments.
6. Choose the reason for submission. Indicate whether you are initiating a new enrollment, changing existing information, or canceling your enrollment.
7. Review the authorization agreement. Make sure to read and agree to the terms specified in this section, as it will confirm your understanding of the EFT process.
8. Sign the form using the written signature of the authorized individual. Include the printed name, title, and submission date to finalize your enrollment.
9. Prepare the necessary documents such as a voided check or bank letter to accompany your form. Ensure these documents meet the requirements specified in the instructions.
10. Submit the completed form along with any required attachments. You can either fax your documents to the specified number or email them to the provided email address.

Get started on your online EFT enrollment today to ensure prompt payment processing.