Get Authorization Agreement For Accounts Payable Electronic ...

This guide provides clear instructions on how to complete the Authorization Agreement For Accounts Payable Electronic Funds Transfer form. Following these steps will ensure that you can successfully receive payments electronically from Magellan Health, Inc.

Follow the steps to complete the form online:

1. Press the 'Get Form' button to obtain the form and open it in the online editor.
2. Enter your company information in the designated fields. Include the company name, address (including city, state, and zip code), billing contact name, contact telephone number, email address for remittance information, and taxpayer identification number (TIN). Ensure that you select the correct check type, either Employer Identification Number or Social Security Number.
3. Fill out the bank information section accurately. Provide the bank name, address (including city, state, and zip code), bank contact name, contact phone number, account type (checking or savings), account name, account number, and the 9-digit bank routing number. It is essential to verify that the routing number is correct for EFT transactions.
4. In the EFT election information section, authorize Magellan Health, Inc. to initiate credit entries to your designated account. Note that this authorization remains in effect until a cancellation notice is submitted. Be sure you understand that a prenote test must be conducted between Magellan and your bank before electronic transfers occur.
5. Sign the form in the 'Authorized Signature' section, and include your title. Date the form in the provided space.
6. Return the completed form via fax, e-mail, or U.S. mail to the address provided for Magellan Health, Inc. Ensure that you retain a copy for your records.

Complete your electronic funds transfer authorization form online today to streamline your payments!