Get the free Anthem EFT Form - Zuleger Advisors

Introducing AS/Alternately Funded Electronic Funds Transfer Anthem introduces Electronic Funds Transfer (EFT), a better way to do business. With EFT, your billed administrative fees and claims are

How to fill out anthem eft form

1. To fill out the Anthem EFT form, start by downloading the form from the official Anthem website or obtaining a copy from your healthcare provider.
2. Begin by providing your personal information, including your full name, date of birth, and contact details.
3. Fill in your Anthem identification number or policy number accurately. This number is typically found on your insurance card or in your policy documents.
4. Indicate the type of bank account you want to link to your Anthem insurance coverage. You will need to provide the bank's routing number and your account number.
5. If you have multiple Anthem policies, specify which policy you want the EFT to apply to.
6. Review the authorization section carefully and ensure all the information you have provided is correct and complete.
7. Sign and date the form to confirm that you authorize Anthem to process your payments through electronic funds transfer.
8. Make a copy of the filled-out form for your records and submit the original to Anthem as per their instructions. This may involve mailing the form to a specific address or submitting it electronically through their online portal.

Who needs Anthem EFT forms?

1. Individuals who have Anthem health insurance policies and wish to have their premium payments automatically deducted from their bank account.
2. Employers or plan sponsors who offer Anthem insurance benefits to their employees and want to set up electronic payment transfers for their group coverage.
3. Healthcare providers who have a contractual agreement with Anthem and need to receive electronic payments from Anthem for services rendered to Anthem-insured individuals.

Note: It is advisable to consult with Anthem or refer to their official resources for specific guidance on filling out the EFT form as requirements may vary or change over time.

For pdfFiller’s FAQs

What is anthem eft form?

Anthem EFT form is a form used by Anthem Blue Cross to collect payment information for electronic funds transfer (EFT) purposes.

Who is required to file anthem eft form?

Healthcare providers who have a contract with Anthem Blue Cross and wish to receive payments through electronic funds transfer (EFT) are required to file the Anthem EFT form.

How to fill out anthem eft form?

To fill out Anthem EFT form, healthcare providers need to provide their banking information, contact information, and other required details as specified on the form.

What is the purpose of anthem eft form?

The purpose of Anthem EFT form is to streamline the payment process for healthcare providers by enabling electronic funds transfer (EFT) payments from Anthem Blue Cross.

What information must be reported on anthem eft form?

Information such as provider's banking details, contact information, tax ID, and other necessary information must be reported on Anthem EFT form.

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