Get Electronic Funds Transfer Verification Form (eft) - Hill Physicians ...

Filling out the Electronic Funds Transfer Verification Form is an essential step for ensuring that your claims payments are directed to the correct bank account. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to successfully complete the eFT form.

1. Press the ‘Get Form’ button to access the Electronic Funds Transfer Verification Form and open it for editing.
2. Begin by entering your practice name in the designated field to identify your organization.
3. Input your tax identification number (TIN) in the appropriate section, ensuring accuracy to avoid any processing delays.
4. Provide the printed name of the authorized representative who is filling out the form, as well as their phone number for any necessary follow-up.
5. Enter the National Provider Identifier (NPI) number for your practice, which is essential for processing payments.
6. Affix the signature of the authorized representative in the designated area to validate the form.
7. Include the email address for future correspondence and confirmation regarding the Electronic Funds Transfer.
8. Enter your Hill inSite username if applicable, ensuring that all information is accurate.
9. Check the appropriate box indicating the action you wish to take: either begin Electronic Funds Transfer or change the current transfer account.
10. Complete the account type section by selecting whether the account is checking, savings, or another type, as well as filling in the routing number and account number for the specified account.
11. If changing accounts, provide both the old account number and the effective date of change to avoid confusion.
12. Review the completed form carefully for any errors or missing information before finishing.
13. Save your changes, and then print the form to retain a copy for your records.
14. Submit the completed form to your Practice Support Advisor or send it via fax to the appropriate contact number listed for your region.

Complete your Electronic Funds Transfer Verification Form online to ensure timely payment processing.