Get Eraeft Enrollment Form - Aetna

This guide provides clear and instructive steps on how to accurately complete the ERAEFT Enrollment Form for Aetna online. By following these steps, you can ensure a smooth enrollment process for electronic funds transfers.

Follow the steps to fill out the enrollment form correctly.

1. Click ‘Get Form’ button to access the ERAEFT Enrollment Form and open it in your editing tool.
2. Start by filling in your provider information, including your full legal name and organizational address. Ensure that all required fields marked with an asterisk are completed.
3. Provide your Provider Identifiers information, including your federal tax identification number (TIN) and national provider identification number (NPI). These are mandatory fields.
4. Next, fill out the provider contact information by including the contact person's name, phone number, and email address. Make sure this information is up-to-date for efficient communication.
5. Move on to the financial institution information section. Here, enter the bank's name, address, routing number, and your account number. Indicate the type of account (checking or saving) and specify how your account links to your provider identifier.
6. Select the reason for submission — whether it is for a new enrollment or a change. Ensure to include a voided check or a bank letter with your submission as this is crucial for processing.
7. In the authorization agreement section, read the terms carefully. You’ll need to provide a written signature, print your name, title, and the date of submission. This confirms consent for the electronic funds transfer.
8. Finally, ensure all sections of the form are completed accurately and clearly. After reviewing your information, you can save your changes, download the form, or print it to submit.

Complete your enrollment forms online today to benefit from seamless electronic funds transfers.