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TRI CARE PRIME ELECTRONIC FUNDS TRANSFER (EFT)/ RECURRING CREDIT CARD (RCC) REQUEST FORM Instructions: Please select the preferred automated payment method and fill out the required fields. Your account
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How to fill out Tricare Prime EFT or:

01
Visit the Tricare website or contact your regional contractor to obtain the necessary forms for setting up Electronic Funds Transfer (EFT) for Tricare Prime.
02
Fill out the required information, including your personal details such as name, address, and social security number. Make sure to provide accurate, up-to-date information to ensure proper processing.
03
Select your bank information, including the name of your financial institution, routing number, and account number. Double-check these details to ensure accuracy and avoid any delays in payment.
04
Indicate whether you are the account holder or an authorized representative. If you are filling out the form on behalf of someone else, provide their name and relationship to you.
05
Review the form for any errors or missing information before submitting it. Ensure that all sections are completed and signed, if required.
06
Once the form is completed, submit it to the appropriate Tricare office or contractor as instructed. Follow their specific guidelines for submission, such as by mail or online.
07
Keep a copy of the completed form for your records, including any confirmation or receipt you receive upon submission. This will serve as proof of your request.

Who needs Tricare Prime EFT or:

01
Tricare Prime beneficiaries who want to have their premium payments deducted electronically from their bank accounts may need to set up Tricare Prime EFT.
02
It may also be necessary for authorized representatives or family members who handle the billing and payments for Tricare Prime beneficiaries to set up EFT on their behalf.
03
Opting for Tricare Prime EFT can provide convenience and peace of mind by automating premium payments, ensuring timely and accurate transactions.
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Tricare Prime EFT is Electronic Funds Transfer system used for payments within the Tricare Prime program.
Healthcare providers who participate in the Tricare Prime program are required to file Tricare Prime EFT.
Providers can fill out Tricare Prime EFT by submitting the necessary information and setting up electronic payment methods.
The purpose of Tricare Prime EFT is to streamline payment processes and ensure healthcare providers receive payment in a timely manner.
Providers must report their banking information, payment preferences, and other necessary details for electronic fund transfers.
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