Get the free Medi-Cal DentalElectronic Funds Transfer (EFT) Enrollment Form

W HCSICALIFORNIA MEDICAL DENTAL PROGRAM P.O. BOX 15609 SACRAMENTO, CALIFORNIA 958520609 Phone: 8004230507 Web: www.dental.dhcs.ca.govMediCal DentalELECTRONIC FUNDS TRANSFER (EFT) ENROLLMENT FORM PROVIDER

How to fill out medi-cal dentalelectronic funds transfer

How to fill out medi-cal dentalelectronic funds transfer

1. To fill out Medi-Cal Dental Electronic Funds Transfer, follow these steps:
2. Obtain the Electronic Funds Transfer (EFT) authorization form from your Medi-Cal Dental Provider.
3. Fill out the provider information section, including your provider name, National Provider Identifier (NPI) number, and provider type.
4. Provide your banking information, including the name of your financial institution, routing number, and account number.
5. Indicate the type of account (checking or savings) by checking the appropriate box.
6. Sign and date the form to authorize Medi-Cal Dental to deposit funds electronically into your designated account.
7. Submit the completed form to the Medi-Cal Dental office or mail it to the designated address.
8. Keep a copy of the filled-out form for your records.

Who needs medi-cal dentalelectronic funds transfer?

1. Any dental provider that accepts payments from Medi-Cal Dental payments can utilize Medi-Cal Dental Electronic Funds Transfer.
2. This service is especially beneficial for dental clinics and individual dental providers who want to receive their payments in a fast and secure manner.
3. By opting for electronic funds transfer, dental providers can avoid delays in receiving their payments and do away with manual payment processing.

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What is medi-cal dental electronic funds transfer?

Medi-Cal Dental Electronic Funds Transfer is a secure way to receive payments from the Medi-Cal Dental Program directly into a provider's bank account.

Who is required to file medi-cal dental electronic funds transfer?

All Medi-Cal dental providers who wish to receive payments electronically are required to file for electronic funds transfer.

How to fill out medi-cal dental electronic funds transfer?

Providers can fill out the electronic funds transfer form online through the Medi-Cal website or by submitting a paper application to the California Department of Health Care Services.

What is the purpose of medi-cal dental electronic funds transfer?

The purpose of Medi-Cal Dental Electronic Funds Transfer is to streamline the payment process for providers and ensure timely receipt of payments.

What information must be reported on medi-cal dental electronic funds transfer?

Providers must report their banking information, including account number and routing number, in order to enroll in the electronic funds transfer system.