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Electronic Funds Transfer (EFT) Application Name of Company Group Number I hereby authorize the Ohio Dental Association Wellness Trust to initiate debit entries to the checking or saving account indicated

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To fill out Zelis - Pay for, follow the steps below: 1. Access the Zelis - Pay for platform.

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What is zelis - pay for?

Zelis - pay is used to pay for medical claims and services.

Who is required to file zelis - pay for?

Healthcare providers and insurance companies are required to file zelis - pay for.

How to fill out zelis - pay for?

Zelis - pay for can be filled out electronically through the Zelis portal or through a third-party billing system.

What is the purpose of zelis - pay for?

The purpose of zelis - pay for is to process and pay medical claims and services accurately and efficiently.

What information must be reported on zelis - pay for?

Information such as patient details, service provided, charges, and insurance information must be reported on zelis - pay for.

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