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Get the free peia.wv.govnewscenterprovider-briefingELECTRONIC FUNDS TRANSFER AUTHORIZATION FORM

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ELECTRONIC FUNDS TRANSFER AUTHORIZATION FORM The information concerning your financial institution will be used to make electronic funds transfer (EFT) payments that are due and approved for payment
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How to fill out peiawvgovnewscenterprovider-briefingelectronic funds transfer authorization

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How to fill out peiawvgovnewscenterprovider-briefingelectronic funds transfer authorization

01
Obtain the Electronic Funds Transfer Authorization form from the PEIA WV GovNews Center Provider Briefing website.
02
Fill out the form with the required information, such as your name, address, and banking details.
03
Review the form to ensure all the information is accurate and complete.
04
Sign and date the form.
05
Submit the form by mailing it to the provided address or by faxing it to the given fax number.

Who needs peiawvgovnewscenterprovider-briefingelectronic funds transfer authorization?

01
Healthcare providers who wish to receive their payments from PEIA electronically through direct deposit need to fill out the PEIA WV GovNews Center Provider Briefing Electronic Funds Transfer Authorization form.
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The peiawvgovnewscenterprovider-briefing electronic funds transfer authorization is a form used to authorize electronic funds transfers for providers.
Providers who wish to receive payments via electronic funds transfer are required to file the authorization form.
Providers can fill out the form by providing their banking information and signing the authorization agreement.
The purpose of the authorization form is to allow providers to receive payments electronically instead of by check.
Providers must report their banking information, such as account number and routing number, on the authorization form.
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