Get Instamed Order Form - Payer Payments - Caresource

The InstaMed Order Form for Payer Payments is designed to simplify the process of receiving payments electronically. This guide will provide you with step-by-step instructions to ensure you accurately complete the form online.

Follow the steps to complete the InstaMed Order Form efficiently.

1. Press the ‘Get Form’ button to obtain the InstaMed Order Form and open it in your preferred editing tool.
2. Review the entire form carefully before entering any information to ensure all requirements are understood.
3. Fill in the customer information section, including your name, legal name, and contact details such as phone number and email address.
4. Provide your billing address accurately, ensuring all fields are completed, including street address, city, state, and zip code.
5. Indicate the number of providers and include your Tax Identification Number (Tax ID) in the designated field.
6. Specify your Patient Accounting System and mention the relevant clearinghouse for receiving electronic remittance advice (ERA).
7. List the National Provider Identifiers (NPI) for your billing providers, ensuring that only applicable NPIs are included.
8. Complete the bank account information section, providing your bank's name, routing number, and account number. A voided check or bank letter will be necessary.
9. Read the Agreed and Accepted section, confirming that the information provided is true. Sign in the designated signature field and date your entry.
10. After filling out the form, save your changes, and ensure you download, print, or securely send the completed form as needed.

Complete your InstaMed Order Form online today for efficient payment processing.