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  • Ga Blue Cross Shield Electronic Funds Transfer Enrollment Form

Get Ga Blue Cross Shield Electronic Funds Transfer Enrollment Form

Presentative. OR Electronic Remittance Advice (ERA) Support 3350 Peachtree Road EDI Services / GA014-0007 Atlanta, Ga 30326 Mail Forms to: Blue Cross Blue Shield of Georgia (888) 883-2720 (ERA only) Complete this form to request scheduling for implementation of EFT for the provider / faciilty indicated below. NOTE: A separate form is required for each Tax Identification Number & Location. Incomplete enrollment form will cause delay. Provider Name: ________________________________________.

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How to fill out the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form online

This guide provides step-by-step instructions on how to complete the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form online. By following these instructions, users can ensure a seamless enrollment process for electronic fund transfers.

Follow the steps to complete the enrollment form effectively.

  1. Click ‘Get Form’ button to obtain the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form and open it in the designated editor.
  2. Begin by entering the 'Provider Name' and 'Provider/Supplier Legal Business Name' in the specified fields. Ensure accurate spelling for proper identification.
  3. Next, input the 'Tax ID Number' and 'Location Suffix'. Remember, a separate form is needed for each Tax Identification Number and its corresponding suffix.
  4. Fill out the 'Physical Address' section, including the 'Suite', 'City', 'State', and 'ZIP Code'. This information will be used for correspondence related to your enrollment.
  5. Provide the 'Contact Name', 'Phone', and 'Fax' numbers for the representative who will manage this enrollment process.
  6. In the 'Direct Deposit Authorization' section, authorize Blue Cross Blue Shield of Georgia to deposit payments to your specified bank account. It is required to attach a copy of a voided check for verification purposes.
  7. Complete the 'Bank Information' section by filling in the 'Name on Bank Account', 'Account Type' (select either Checking or Savings), 'Bank Name', 'Branch Name', 'Bank Address', 'Bank Phone Number', 'Account Number', and 'Transit/ABA Number'.
  8. An authorized signer on the bank account must sign the form. Enter the 'Authorized/Delegated Official Name', 'Title', and provide their signature. Ensure that the date signed is also included.
  9. After filling out all fields correctly, save your changes. You may choose to download, print, or share the completed form as needed.

Complete your enrollment form online today for a quick and efficient processing of your electronic funds transfer.

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To make an EFT payment, utilize the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form to enroll in the service. After enrollment, you will have the ability to set up automatic payments or make one-time payments directly from your bank account. Ensure you have your payment details handy for a smooth transaction. This feature offers convenience and reliability in your financial interactions.

To perform an electronic funds transfer using the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form, start by logging into your online banking account. From there, select the option for electronic transfers and input the necessary information, including the details from your enrollment form. Confirm the transaction to initiate the transfer securely. This simplifies your payment processes and enhances your financial management.

To complete the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form, begin by gathering your banking information, including account numbers and routing numbers. Next, visit the US Legal Forms platform where you can easily access the enrollment form. After filling out the form with accurate details, submit it according to the provided instructions. This process ensures you can initiate seamless electronic fund transfers.

The Blue Cross Blue Shield of Georgia is often referred to simply as Blue Cross or as Anthem Blue Cross Blue Shield of Georgia. This designation reflects the company's affiliation with Anthem while they provide insurance solutions under the Blue Cross Blue Shield brand. Knowing the correct terminology can help you when searching for the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form or other related documents.

Filling out the EFT authorization form requires providing specific personal and banking information. This includes your practice name, tax ID, bank name, and account details. As you complete the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form, it is vital to double-check all entries for accuracy to avoid delays in processing your electronic payments.

Enrolling in EFT and Electronic Remittance Advice (ERA) typically involves completing the necessary forms provided by your insurance carrier, such as the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form. Be sure to gather required information, such as bank details and your provider identifier. Following the instructions carefully will ensure a smooth enrollment process.

An Electronic Funds Transfer (EFT) enrollment form allows you to authorize automatic payment transactions. This form is crucial for providers who wish to receive payments electronically from insurance companies seamlessly. Completing the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form helps streamline your revenue cycle, reducing the time and effort spent on payment processing.

Anthem Georgia is a member of the Blue Cross Blue Shield Association, but it functions as its own entity. This means you can find specific coverage options tailored to Georgia residents through Anthem. However, always verify the details of your plan, including those related to the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form, to ensure you meet all requirements.

The primary difference lies in their structure and offerings. Anthem Inc. operates as a health insurance provider under the Blue Cross Blue Shield brand. While both provide extensive coverage options, Anthem's plans might include unique features not found with other Blue Cross Blue Shield affiliates. When filling out the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form, it's helpful to know which specific services apply to you.

To fill out the EFT authorization form, begin by providing your complete contact information and bank account details. Be clear about the payments you wish to authorize, and double-check all entries for accuracy. Once completed, sign and date the form to confirm your agreement. Utilizing the GA Blue Cross Shield Electronic Funds Transfer Enrollment Form simplifies this process, making it easy to handle your transactions.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
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 WorkFlow
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
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