Get the free regence provider eftach form

AUTOMATIC DEPOSIT (EFT/ACH CREDITS) AUTHORIZATION AGREEMENT AND CONTACT INFORMATION All fields are required Date: Provider Organization Name: Tax Identification (ID): Please set up ALL National Provider

How to fill out regence provider eftach form

How to fill out regence provider eftach form?

1. Begin by downloading the regence provider eftach form from the official Regence website or requesting a physical copy from their office.
2. Fill in your personal information, such as your name, contact details, and any affiliations with medical institutions or organizations.
3. Provide your banking information, including your account number and routing number, to ensure that payments can be transferred electronically.
4. Indicate the type of payments you wish to receive through the eftach system, whether it's reimbursement for medical services or other related payments.
5. Sign and date the form to confirm that the information provided is accurate and that you authorize Regence to make electronic transfers to your designated bank account.

Who needs regence provider eftach form?

1. Healthcare providers who offer medical services and receive payments from Regence insurance company.
2. Physicians, hospitals, clinics, and other medical professionals who want to streamline their payment process and receive electronic payments instead of traditional checks.
3. Any healthcare provider who wants to ensure secure and efficient financial transactions with Regence and reduce the administrative burden associated with paper-based payments.

For pdfFiller’s FAQs

What is regence provider eftach form?

Regence provider eftach form is a document used by healthcare providers to submit electronic claims to Regence, a health insurance company.

Who is required to file regence provider eftach form?

Healthcare providers who are contracted with Regence are required to file the provider eftach form.

How to fill out regence provider eftach form?

To fill out the regence provider eftach form, providers need to enter the required information accurately, including patient demographics, diagnosis codes, procedure codes, and billing information.

What is the purpose of regence provider eftach form?

The purpose of the regence provider eftach form is to electronically submit claims and billing information to Regence for reimbursement.

What information must be reported on regence provider eftach form?

The regence provider eftach form requires reporting of patient demographic information, diagnosis codes, procedure codes, and billing information for the services provided.

When is the deadline to file regence provider eftach form in 2023?

The deadline to file the regence provider eftach form in 2023 is unknown. Please refer to the official communication from Regence for specific deadlines.

What is the penalty for the late filing of regence provider eftach form?

The penalty for the late filing of the regence provider eftach form may vary depending on the terms of the provider's contract with Regence. It is recommended to consult the contract or contact Regence directly for information on penalties.

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