Electronic Funds Transfer (EFT)

To enroll in or update Electronic Funds Transfer (EFT), please submit the following documents to [email protected].

1. Completed EFT Form
2. Voided check 
3. Bank letter  
4. Updated W9

 

Please note, without these completed documents, your EFT form cannot be processed. 

Please allow up to 30 business days upon receipt of all required information and supporting documents to process all EFT requests

For any questions or concerns related to this matter, please contact your Provider Relations Account Manager or email:  [email protected].

 

 Electronic Funds Transfer (EFT) Form