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Get Echo Eft And Era Enrollment Form 2022-2024

The form and fill in the information. Complete all sections that apply to your enrollment choice (EFT, ERA, or both EFT and ERA). Enrollments are handled at the TAX ID level. All NPIs associated with the specified TIN will be automatically enrolled. If your TAX ID would like to receive payments via more than one bank account, please contact EDI EchoHealthinc.com. Be sure to sign the form. Fax, postal mail or email the completed form (secure email is recommended if you choose this me.

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