> [llms.txt](https://getlemma.com/llms.txt)

# Insurance Payer EFT Network

Lemma maintains a network of insurance payers. We routinely document paths to change the bank account payers deposit EFTs into.

## How to read the table

Bank change methods are the ways a provider can change the bank account a payer deposits into: Online portal, Documents, Form, Phone. A payer with no method listed has no published route, so call or email its provider services. Operating state "Nationwide" means the payer operates in every state.

## 2,356 payers

| Payer | Coverage types | Operating states | Programs | Bank change methods |
| --- | --- | --- | --- | --- |
| AARP UnitedHealthCare Insurance Company | Medical, Dental, Vision | Nationwide | Commercial, Medicare, Medicare Advantage | Online portal, Documents |
| Aetna | Medical, Dental, Vision | Nationwide | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Aetna Better Health | Medical, Dental, Vision | AZ, FL, IL, KY, LA, MD, MI, NJ, NY, OH, OK, PA, TX, VA, WV | Medicaid, Medicare | Online portal, Documents, Form |
| Aetna Better Health - Nevada | Medical, Dental, Vision | NV | Medicaid, Medicare | Online portal, Documents, Form |
| Aetna Better Health California | Medical, Dental, Vision | CA | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Florida | Medical, Dental, Vision | FL | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Kansas | Medical, Dental | KS | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Kentucky | Medical, Dental | KY | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Louisiana | Medical | LA | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Maryland | Medical, Dental | MD | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Michigan | Medical, Dental, Vision | MI | Medicaid, Medicare Advantage | Online portal, Documents, Form |
| Aetna Better Health New Jersey | Medical, Dental | NJ | Medicaid | Online portal, Documents, Form |
| Aetna Better Health New York | Medical, Dental | NY | Medicaid | Online portal, Documents, Form |
| Aetna Better Health of Illinois | Medical, Dental, Vision | IL | Medicaid | Online portal, Documents, Form |
| Aetna Better Health of West Virginia | Medical, Dental | WV | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Ohio | Medical, Dental | OH | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Oklahoma | Medical, Dental, Vision | OK | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Pennsylvania | Medical, Dental, Vision | PA | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Texas | Medical, Dental | TX | Medicaid | Online portal, Documents, Form |
| Aetna Better Health Virginia | Medical, Dental | VA | Medicaid | Online portal, Documents, Form |
| Aetna Dental Medicare | Medical, Dental, Vision | Nationwide | Medicare Advantage | Online portal |
| Aetna Medicaid Illinois | Medical | IL | Medicaid | Online portal, Documents, Form |
| Aetna OhioRISE Medicaid Managed Care Entity | Medical, Vision | OH | Medicaid | Online portal, Documents, Form |
| AFLAC | Medical, Dental | Nationwide | Commercial | Online portal |
| Alignment Health Plan | Medical, Dental, Vision | CA, NV, NC, TX | Medicare Advantage | Online portal |
| Allegiance Benefit Plan Management Incorporated | Medical, Dental, Vision | CA, CO, ID, IL, IA, KS, MN, MT, NE, ND, SD, UT, WA, WI, WY | Commercial | Online portal |
| Alterwood Advantage | Medical | MD | Medicaid, Medicare Advantage | Online portal |
| Altrua Healthshare | Medical | Nationwide |  | Online portal |
| Amerigroup | Medical, Dental, Vision | GA, MD, NM, DC | Medicaid, Medicare | Online portal, Documents |
| AmeriHealth | Medical, Dental, Vision | DE, NJ, PA | Commercial, Medicare Advantage | Online portal |
| AmeriHealth - Delaware (Non HMO) | Medical | DE | Commercial | Online portal |
| AmeriHealth Caritas Delaware | Medical, Dental | DE | Medicaid | Online portal |
| AmeriHealth Caritas District of Columbia | Medical, Dental | DC | Medicaid | Online portal |
| AmeriHealth Caritas Florida | Medical | FL | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas Louisiana | Medical, Dental | LA | Medicaid | Online portal |
| AmeriHealth Caritas New Hampshire | Medical, Dental | NH | Medicaid | Online portal |
| AmeriHealth Caritas Next (Delaware) | Medical | DE | Commercial | Online portal |
| AmeriHealth Caritas Next (Florida) | Medical | FL | Commercial | Online portal |
| AmeriHealth Caritas Next (Louisiana) | Medical | LA | Commercial | Online portal |
| AmeriHealth Caritas Next (North Carolina) | Medical | NC | Commercial | Online portal |
| AmeriHealth Caritas North Carolina | Medical, Dental, Vision | ND | Medicaid | Online portal |
| AmeriHealth Caritas Northeast | Medical, Dental | PA | Medicaid | Online portal |
| AmeriHealth Caritas Ohio | Medical, Dental | OH | Medicaid | Online portal |
| AmeriHealth Caritas Ohio (Transportation Only)  | Medical | OH | Medicaid | Online portal |
| AmeriHealth Caritas Pennsylvania | Medical, Dental | PA | Medicaid | Online portal |
| AmeriHealth Caritas Pennsylvania Dental | Dental | PA | Medicaid | Online portal |
| AmeriHealth Caritas VIP Care | Medical | PA | Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care - Michigan HIDE SNP | Medical | MI | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care – Delaware | Medical | DE | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care – Florida | Medical | FL | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care – Louisiana | Medical | LA | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care – North Carolina | Medical | NC | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care – Pennsylvania | Medical | PA | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care Delaware Dual Special Needs Plan | Medical | DE | Medicaid, Medicare Advantage | Online portal |
| AmeriHealth Caritas VIP Care Plus | Medical | MI | Medicaid, Medicare | Online portal |
| AmeriHealth NJ | Medical, Dental, Vision | NJ | Commercial, Medicare Advantage | Online portal |
| Anthem Blue Cross and Blue Shield Nevada | Medical, Dental, Vision | NV | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross and Blue Shield Nevada - Dental | Medical, Dental | NV | Commercial | Online portal |
| Anthem Blue Cross and Blue Shield New Hampshire | Medical, Dental, Vision | NH | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross and Blue Shield New Hampshire - Dental | Medical, Dental | NH | Commercial | Online portal |
| Anthem Blue Cross and Blue Shield Virginia | Medical, Dental, Vision | VA | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross and Blue Shield Virginia - Dental | Medical, Dental | VA | Commercial | Online portal |
| Anthem Blue Cross and Blue Shield Wisconsin | Medical, Dental, Vision | WI | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross and Blue Shield Wisconsin - Dental | Medical, Dental | WI | Commercial | Online portal |
| Anthem Blue Cross Blue Shield Missouri | Medical, Dental, Vision | MO | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield Missouri - Dental | Medical, Dental | MO | Commercial | Online portal |
| Anthem Blue Cross Blue Shield of California | Medical, Dental, Vision | CA | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield of Colorado | Medical, Dental, Vision | CO | Commercial, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield of Colorado - Dental | Medical, Dental | CO | Commercial | Online portal |
| Anthem Blue Cross Blue Shield of Connecticut | Medical, Dental, Vision | CT | Medicaid | Online portal, Documents |
| Anthem Blue Cross Blue Shield of Connecticut - Dental | Medical, Dental | CT | Commercial | Online portal |
| Anthem Blue Cross Blue Shield of Connecticut Federal Employees Program | Medical | CT | Commercial | Online portal |
| Anthem Blue Cross Blue Shield of Georgia | Medical, Dental, Vision | GA | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield of Indiana | Medical, Dental, Vision | IN | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield of Indiana - Dental | Medical, Dental | IN | Commercial | Online portal |
| Anthem Blue Cross Blue Shield of Maine | Medical, Dental, Vision | ME | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield of Maine - Dental | Medical, Dental | ME | Commercial | Online portal |
| Anthem Blue Cross Blue Shield of New York | Medical, Dental, Vision | NY | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield Ohio | Medical, Dental, Vision | OH | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem Blue Cross Blue Shield Ohio - Dental | Medical, Dental | OH | Commercial | Online portal |
| Anthem Blue Cross of New York Dental | Medical, Dental, Vision | NY | Commercial | Online portal |
| Anthem BlueCross BlueShield Kentucky | Medical, Dental, Vision | KY | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Anthem BlueCross BlueShield Kentucky - Dental | Medical, Dental | KY | Commercial | Online portal |
| Anthem Maine Health | Medical, Dental, Vision | ME | Commercial, Medicaid, Medicare Advantage | Online portal |
| Anthem MaineHealth | Medical, Dental, Vision | ME | Commercial, Medicare Advantage | Online portal, Documents |
| ArcBest Corporation | Medical |  | Commercial | Online portal |
| Arkansas Blue Cross and Blue Shield | Medical, Dental, Vision | AR | Commercial, Medicare Advantage | Online portal, Documents |
| ASA GEHA | Medical, Dental, Vision | Nationwide | Commercial | Online portal, Documents |
| Atrio Health Plans | Medical, Dental | NV, OR | Medicare Advantage | Online portal |
| Banner Medicare Advantage Dual HMO D-SNP | Medical | AZ | Medicaid, Medicare Advantage | Online portal |
| Banner Medicare Advantage Prime HMO  | Medical, Dental, Vision | AZ, ID, MT, WY | Medicare Advantage | Online portal |
| Blue Cross and Blue Shield of Illinois | Medical, Dental, Vision | AZ, FL, IL, IN, NV, OK | Commercial, Medicaid, Medicare | Online portal, Documents |
| Blue Cross and Blue Shield of Kansas | Medical, Dental, Vision | KS | Commercial, Medicare Advantage | Form |
| Blue Cross and Blue Shield of Minnesota | Medical, Dental, Vision | MN | Commercial, Medicaid, Medicare Advantage | Form |
| Blue Cross and Blue Shield of Montana | Medical, Dental, Vision | MT | Commercial, Medicare Advantage | Online portal, Documents |
| Blue Cross and Blue Shield of Nebraska | Medical, Dental, Vision | NE | Commercial, Medicare Advantage | Online portal, Documents |
| Blue Cross and Blue Shield of New Mexico | Medical, Dental, Vision | NM | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Blue Cross and Blue Shield of Texas | Medical, Dental, Vision | CT, IL, NM, TX, UT | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Blue Cross Blue Shield FEP BlueDental | Dental | Nationwide | Commercial | Online portal, Documents |
| Blue Cross Blue Shield of Massachusetts | Medical, Dental, Vision | MA, NH | Commercial, Medicare Advantage | Online portal |
| Blue Cross Blue Shield of Michigan | Medical, Dental, Vision | AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, SC, SD, TN, TX, UT, VT, VA, WA, WI, DC | Commercial, Medicare | Online portal, Documents |
| Blue Cross Blue Shield of North Dakota | Medical, Dental, Vision | ND | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Blue Cross Blue Shield of Wyoming | Medical, Dental, Vision | WY | Commercial, Medicare Advantage | Online portal, Documents |
| Blue Cross Blue Shield Oklahoma | Medical, Dental, Vision | OK | Commercial, Medicare Advantage | Online portal, Documents |
| Blue Cross Blue Shield Texas Medicaid STAR CHIP | Medical, Dental | TX | Medicaid | Online portal, Documents |
| Blue Cross Community Health Plans | Medical, Dental | IL | Commercial, Medicaid, Medicare Advantage | Online portal |
| Blue Cross Complete of Michigan | Medical, Dental | MI | Medicaid | Online portal |
| BlueCross BlueShield of Tennessee | Medical, Dental, Vision | TN | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Braven Health | Medical, Dental, Vision | NJ | Medicare Advantage | Online portal |
| Buckeye Health Plan | Medical, Dental, Vision | OH | Medicaid, Medicare Advantage | Online portal |
| Capital Blue Cross of Pennsylvania | Medical, Dental, Vision | PA | Commercial, Medicare Advantage | Online portal, Documents |
| Capital Health Plan | Medical, Vision | FL | Commercial, Medicare Advantage | Online portal |
| CareFirst Administrators | Medical, Dental, Vision | MD, VA, DC | Commercial | Online portal |
| CareFirst Blue Cross Blue Shield Maryland | Medical, Dental, Vision | DE, FL, MD, NC, PA, VA, WV, DC | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| CareFirst BlueCross BlueShield Medicare Advantage | Medical, Dental, Vision | MD, VA, DC | Medicare Advantage | Online portal |
| Carelon Behavioral Health | Medical, Dental | Nationwide | Commercial, Medicaid, Medicare | Online portal, Documents |
| CareOregon | Medical, Dental, Vision | OR | Medicaid | Online portal |
| CarePartners of Connecticut | Medical, Dental, Vision | CT | Medicare Advantage | Online portal |
| CarePlus | Medical, Dental | FL | Medicare Advantage | Online portal |
| CareSource (Common Ground Healthcare Cooperative ) | Medical, Vision | WI | Commercial | Online portal |
| CareSource Georgia (Marketplace) | Medical, Dental, Vision | GA | Commercial | Online portal |
| CareSource Indiana | Medical, Dental, Vision | IN | Commercial | Online portal |
| CareSource Kentucky | Medical, Dental, Vision | KY | Medicaid | Online portal |
| Caresource Military and Veterans | Medical | FL, GA | TRICARE | Online portal |
| CareSource Nevada Marketplace | Medical, Vision | NV | Commercial | Online portal |
| CareSource Nevada Medicaid | Medical, Vision | NV | Medicaid | Online portal |
| CareSource of Michigan Medicaid | Medical, Dental, Vision | MI | Medicaid | Online portal |
| CareSource Ohio Marketplace | Medical, Dental, Vision | GA, OH | Medicaid | Online portal |
| CareSource Ohio Medicaid | Medical, Dental, Vision | OH | Medicaid | Online portal |
| CareSource PASSE | Medical, Vision | AR | Medicaid | Online portal |
| CDPHP | Medical, Dental, Vision | NY | Commercial | Online portal |
| Centene (Behavioral Health) | Medical, Dental | Nationwide | Medicaid | Online portal |
| Centene (Medical) | Medical, Dental, Vision | Nationwide | Commercial, Medicaid, Medicare Advantage | Online portal |
| Central California Alliance for Health | Medical, Dental | CA | Medicaid | Online portal |
| Chorus Community Health Plans | Medical | WI | Commercial, Medicaid | Online portal |
| Cigna | Medical, Dental, Vision | Nationwide | Commercial | Online portal |
| Clear Health Alliance | Medical | FL | Medicaid | Online portal, Documents |
| Colorado Community Health Alliance | Medical, Dental | CO | Medicaid | Online portal, Documents |
| Community First Health Plans | Medical | TX | Commercial, Medicaid, Medicare Advantage | Online portal |
| Cook Children's Health Plan (CHIP) | Medical, Dental | TX | Medicaid | Online portal |
| Cook Children's Health Plan (STAR) | Medical | TX | Medicaid | Online portal |
| CountyCare | Medical | IL | Medicaid | Online portal |
| Delta Dental - DDIC | Dental | AL, FL, GA, LA, MS, MT, NV, TX, UT | Commercial, Medicare | Online portal, Documents |
| Delta Dental (Individual Plans) | Dental | CO, CT, IL, NJ, VA, WI | Commercial | Online portal, Documents |
| Delta Dental Arizona | Dental | AZ | Commercial | Online portal, Documents |
| Delta Dental Arkansas | Dental | AR | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Delta Dental Colorado | Dental | CO | Commercial, Medicare Advantage | Online portal, Documents |
| Delta Dental Illinois | Dental | IL | Commercial, Medicare Advantage | Online portal, Documents |
| Delta Dental Indiana | Dental | IN | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Delta Dental Michigan | Dental | MI | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Delta Dental New Mexico | Dental | NM | Commercial | Online portal, Documents |
| Delta Dental New York | Dental | NY | Commercial | Online portal, Documents |
| Delta Dental North Carolina | Dental | NC | Commercial, Medicare Advantage | Online portal, Documents |
| Delta Dental of Alaska | Dental | AK | Commercial | Online portal, Documents |
| Delta Dental of California | Dental | CA | Commercial | Online portal, Documents |
| Delta Dental of Delaware | Dental | DE | Commercial | Online portal, Documents |
| Delta Dental of District of Columbia (D.C.) | Dental | DC | Commercial | Online portal, Documents |
| Delta Dental of Idaho | Dental | ID | Commercial | Online portal, Documents |
| Delta Dental of Iowa | Dental | IA | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Delta Dental of Iowa - Dental Wellness Plan (DWP) | Dental | IA | Medicaid | Online portal, Documents |
| Delta Dental of Kansas | Dental | KS | Commercial | Online portal, Documents |
| Delta Dental of Kentucky | Dental | KY | Commercial | Online portal, Documents |
| Delta Dental of Maryland | Dental | DE, MD, NY, PA, WV, DC | Commercial | Online portal, Documents |
| Delta Dental of Massachusetts | Dental | MA | Commercial | Online portal, Documents |
| Delta Dental of Minnesota | Dental | MN | Commercial | Online portal, Documents |
| Delta Dental of Missouri | Dental | MO | Commercial | Online portal, Documents |
| Delta Dental of Nebraska | Dental | NE | Commercial | Online portal, Documents |
| Delta Dental of New Jersey | Dental | NJ | Commercial | Online portal, Documents |
| Delta Dental of Northeast | Dental | ME, NH, VT | Commercial, Medicare Advantage | Online portal, Documents |
| Delta Dental of Ohio | Dental | OH | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Delta Dental of Oklahoma | Dental | OK | Commercial | Online portal, Documents |
| Delta Dental of Oregon | Dental, Vision | OR | Commercial, Medicare, Medicare Advantage | Online portal, Documents |
| Delta Dental of Pennsylvania | Dental | PA | Commercial | Online portal, Documents |
| Delta Dental of Puerto Rico | Dental | PR | Commercial | Online portal, Documents |
| Delta Dental of Rhode Island | Dental | RI | Commercial | Online portal, Documents |
| Delta Dental of South Carolina | Dental | SC | Commercial | Online portal, Documents |
| Delta Dental of South Dakota | Dental | SD | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Delta Dental of South Dakota (Medicare Advantage) | Dental | SD | Medicare | Online portal, Documents |
| Delta Dental of Tennessee | Dental | TN | Commercial | Online portal, Documents |
| Delta Dental of Virginia | Dental | VA | Commercial, Medicare Advantage | Online portal, Documents |
| Delta Dental of Washington | Dental | WA | Commercial, Medicare | Online portal, Documents |
| Delta Dental of West Virginia | Dental | WV | Commercial | Online portal, Documents |
| Delta Dental of Wisconsin | Dental | WI | Commercial, Medicare Advantage | Online portal, Documents |
| Delta Dental of Wyoming | Dental | WY | Commercial | Online portal, Documents |
| Denver Health Medical Plan Incorporated (Medicare Choice) | Medical | CO | Commercial, Medicaid, Medicare Advantage | Online portal |
| Devoted Health | Medical, Dental | AL, AZ, AR, CO, DE, FL, GA, HI, IL, IN, IA, KS, KY, LA, MS, MO, NE, NM, NC, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA | Medicare Advantage | Online portal |
| DHMN Santa Cruz | Medical | CA |  | Online portal |
| Direct Care Administrators | Medical, Vision | UT | Commercial | Online portal |
| Driscoll Health Plan | Medical, Dental | TX | Medicaid | Online portal, Documents |
| Essence Healthcare | Medical, Dental | IL, MO, NY, WA | Medicare Advantage | Online portal |
| Fallon Health | Medical, Dental | MA | Commercial, Medicaid, Medicare Advantage | Online portal |
| First Choice Health | Medical | AK, ID, MT, ND, OR, SD, WA, WY | Commercial | Online portal |
| Florida Blue | Medical, Dental, Vision | FL | Commercial, Medicare Advantage | Online portal |
| Geisinger Health Plan | Medical, Dental, Vision | PA | Commercial, Medicaid, Medicare Advantage | Online portal |
| GlobalHealth | Medical | OK | Commercial, Medicaid, Medicare Advantage | Online portal |
| Gold Kidney Health Plan | Medical | AZ | Medicare Advantage | Online portal |
| Golden Rule | Medical, Dental | Nationwide | Commercial | Online portal, Documents |
| Great Bay Administrators | Medical, Dental |  |  | Online portal |
| Harmony Health Plan | Medical | IL | Medicare | Online portal |
| Harvard Pilgrim Health Care | Medical, Dental, Vision | ME, MA, NH, RI, VT | Commercial | Online portal |
| Health Alliance Plan (Michigan) | Medical, Vision | MI | Commercial, Medicaid, Medicare Advantage | Form |
| Health First | Medical | FL | Commercial, Medicare Advantage | Online portal |
| Health Net Claims (California Oregon) | Medical, Dental, Vision | CA, OR | Commercial, Medicaid, Medicare Advantage | Online portal |
| Health Plan of Nevada | Medical, Dental | NV | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Health Valley Provider Network | Medical | CA |  | Online portal |
| HealthChoice of Oklahoma | Medical, Dental, Vision | OK | Commercial | Online portal |
| Healthfirst | Medical, Dental, Vision | NJ, NY | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| HealthSmart Benefit Solutions | Medical, Dental | TN | Commercial | Online portal |
| HealthSun Health Plans | Medical | FL | Medicare Advantage | Online portal, Documents |
| HealthTeam Advantage | Medical | NC | Medicare Advantage | Online portal |
| Healthy Blue Kansas | Medical, Dental, Vision | KS | Medicaid, Medicare Advantage | Online portal, Documents |
| Healthy Blue Louisiana | Medical, Dental, Vision | LA | Medicaid, Medicare Advantage | Online portal, Documents |
| Healthy Blue Missouri | Medical, Dental, Vision | MO | Medicaid, Medicare Advantage | Online portal, Documents |
| Healthy Blue Nebraska | Medical | NE | Medicaid | Online portal, Documents |
| Healthy Blue North Carolina | Medical, Dental, Vision | NC | Medicaid, Medicare Advantage | Online portal, Documents |
| Healthy Blue South Carolina | Medical, Dental, Vision | SC | Medicaid | Online portal, Documents |
| Highmark Blue Cross Blue Shield (NY) - Medicaid and CHP | Medical, Dental, Vision | NY | Medicaid | Online portal, Documents |
| Highmark Blue Cross Blue Shield (Western and Northeastern NY) | Medical, Dental, Vision | NY | Commercial, Medicaid, Medicare Advantage | Phone |
| Highmark Blue Cross Blue Shield of Delaware | Medical, Dental, Vision | DE | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Highmark Blue Cross Blue Shield of West Virginia | Medical, Dental, Vision | WV | Commercial, Medicare Advantage | Online portal, Documents |
| Highmark Blue Cross Blue Shield of Western New York | Medical, Dental, Vision | NY | Commercial, Medicaid, Medicare Advantage | Phone |
| Highmark Pennsylvania Central Region | Medical, Dental, Vision | PA | Commercial, Medicare Advantage | Online portal |
| Highmark Pennsylvania Southeastern Region | Medical | PA | Commercial, Medicare Advantage | Online portal |
| Highmark Pennsylvania Western Region | Medical, Dental | PA | Commercial, Medicaid, Medicare, Medicare Advantage | Online portal, Documents |
| Highmark Senior Health Company | Medical, Dental | PA | Medicare Advantage | Online portal |
| Highmark Senior Solutions | Medical | WV | Medicare Advantage | Online portal |
| Highmark Wholecare Medicare Assured | Medical, Dental | PA | Medicaid, Medicare Advantage | Online portal |
| Horizon Blue Cross and Blue Shield of New Jersey | Medical, Dental, Vision | DE, FL, NJ, NY, PA, SC | Commercial, Medicare | Online portal, Documents |
| Humana | Medical, Dental, Vision | Nationwide | Medicaid, Medicare Advantage | Online portal |
| Humana (KV) - JVHL | Medical |  |  | Online portal |
| Humana Dental | Dental |  | Commercial | Online portal |
| Humana Health Plan Ohio | Medical | OH | Medicaid | Online portal |
| Humana Healthy Horizons in Ohio | Medical, Dental, Vision | OH | Medicaid | Online portal |
| Independence Administrators | Medical, Dental, Vision | PA | Commercial | Online portal |
| Independence Blue Cross | Medical, Dental, Vision | PA | Commercial, Medicare Advantage | Form |
| Innovation Health | Medical, Dental, Vision | MD, VA, DC | Commercial, Medicare Advantage | Online portal |
| IntegraNet Health | Medical, Dental | TX | Commercial | Online portal |
| Jefferson Health Plans | Medical, Dental | PA | Medicaid, Medicare Advantage | Online portal |
| Johns Hopkins Advantage MD | Medical, Dental | MD | Medicare Advantage | Online portal |
| Johns Hopkins Health Plans | Medical, Dental | MD | Commercial, Medicaid, Medicare Advantage | Online portal |
| Johns Hopkins U.S. Family Health Plan (USFHP) | Medical, Vision | MD | TRICARE | Online portal |
| KeyCare Advantage | Medical | MD | Medicare Advantage | Online portal |
| Keystone Health Plan East | Medical, Dental, Vision | PA | Commercial | Online portal |
| L.A. Care Health Plan (California) | Medical, Dental | CA | Commercial, Medicaid | Online portal |
| LACH HealthNet by MedPoint | Medical | CA | Medicaid | Online portal |
| Liberty Dental Plan | Dental | CA, FL, HI, IL, MS, MO, NV, NJ, NY, OK, TX | Commercial, Medicaid | Online portal |
| LifeWise Assurance Company | Medical, Dental | AK, OR, WA | Commercial | Online portal |
| LifeWorks Advantage | Medical | LA, VA | Medicare Advantage | Online portal |
| Marketplace (ACA) plans | Medical |  | Commercial | Online portal, Documents |
| Maryland Medicare Part A | Medical | MD | Medicare | Online portal, Documents |
| Mass General Brigham Health Plan | Medical, Dental, Vision | ME, MA, NH, RI, VT | Commercial, Medicaid, Medicare Advantage | Online portal |
| Medica Government Programs | Medical, Dental | MN | Medicaid | Online portal |
| Medica Individual and Family | Medical, Dental | IA, KS, MN, MO, NE, ND, OK, WI | Commercial | Online portal |
| Medicare Alabama Part A | Medical, Dental | AL | Medicare | Online portal, Documents |
| Medicare Alabama Part B | Medical, Dental | AL | Medicare | Online portal, Documents |
| Medicare Alaska Part A | Medical, Dental | AK | Medicare | Online portal, Documents |
| Medicare Alaska Part B | Medical | AK | Medicare | Online portal, Documents |
| Medicare American Samoa Part A | Medical | AS | Medicare | Online portal, Documents |
| Medicare American Samoa Part B | Medical | AS | Medicare | Online portal, Documents |
| Medicare Arizona Part A | Medical | AZ | Medicare | Online portal, Documents |
| Medicare Arizona Part B | Medical, Dental | AZ | Medicare | Online portal, Documents |
| Medicare Arkansas Part A | Medical | AR | Medicare | Online portal, Documents |
| Medicare Arkansas Part B | Medical, Dental | AR | Medicare | Online portal, Documents |
| Medicare California Part A | Medical, Dental | CA | Medicare | Online portal, Documents |
| Medicare Colorado Part A | Medical | CO | Medicare | Online portal, Documents |
| Medicare Colorado Part B | Medical, Dental | CO | Medicare | Online portal, Documents |
| Medicare Connecticut Part A | Medical | CT | Medicare | Online portal, Documents |
| Medicare Connecticut Part B | Medical, Dental | CT | Medicare | Online portal, Documents |
| Medicare Delaware Part A | Medical | DE | Medicare | Online portal, Documents |
| Medicare Delaware Part B | Medical | DE | Medicare | Online portal, Documents |
| Medicare District of Columbia Part A | Medical | DC | Medicare | Online portal, Documents |
| Medicare District of Columbia Part A (J12 Highmark) | Medical | DC | Medicare | Online portal, Documents |
| Medicare District of Columbia Part B | Medical, Dental | DC | Medicare | Online portal, Documents |
| Medicare Florida Part A | Medical, Dental | FL | Medicare | Online portal, Documents |
| Medicare Florida Part B | Medical, Dental | FL | Medicare | Online portal, Documents |
| Medicare Georgia Part A | Medical | GA | Medicare | Online portal, Documents |
| Medicare Georgia Part B | Medical, Dental | GA | Medicare | Online portal, Documents |
| Medicare Home Health and Hospice J15 | Medical, Dental | CO, DE, IA, KS, MD, MO, MT, NE, ND, PA, SD, UT, VA, WV, WY, DC | Medicare | Online portal, Documents |
| Medicare Idaho Part A | Medical | ID | Medicare | Online portal, Documents |
| Medicare Idaho Part B | Medical | ID | Medicare | Online portal, Documents |
| Medicare Illinois Part A | Medical | IL | Medicare | Online portal, Documents |
| Medicare Illinois Part B | Medical, Dental | IL | Medicare | Online portal, Documents |
| Medicare Indiana Part A | Medical | IN | Medicare | Online portal, Documents |
| Medicare Indiana Part B | Medical, Dental | IN | Medicare | Online portal, Documents |
| Medicare Iowa Part A | Medical | IA | Medicare | Online portal, Documents |
| Medicare Iowa Part B | Medical | IA | Medicare | Online portal, Documents |
| Medicare Kansas Part A | Medical | KS | Medicare | Online portal, Documents |
| Medicare Kansas Part B | Medical, Dental | KS | Medicare | Online portal, Documents |
| Medicare Kentucky Part A | Medical, Dental | KY | Medicare | Online portal, Documents |
| Medicare Kentucky Part B | Medical, Dental | KY | Medicare | Online portal, Documents |
| Medicare Louisiana Part A | Medical | LA | Medicare | Online portal, Documents |
| Medicare Louisiana Part B | Medical, Dental | LA | Medicare | Online portal, Documents |
| Medicare Maine Part A | Medical | ME | Medicare | Online portal, Documents |
| Medicare Maine Part B | Medical, Dental | ME | Medicare | Online portal, Documents |
| Medicare Maryland Part B | Medical, Dental | MD | Medicare | Online portal, Documents |
| Medicare Massachusetts Part A | Medical | MA | Medicare | Online portal, Documents |
| Medicare Massachusetts Part B | Medical, Dental | MA | Medicare | Online portal, Documents |
| Medicare Michigan Part A | Medical, Dental | MI | Medicare | Online portal, Documents |
| Medicare Michigan Part B | Medical, Dental | MI | Medicare | Online portal, Documents |
| Medicare Minnesota Part A | Medical, Dental | MN | Medicare | Online portal, Documents |
| Medicare Minnesota Part B | Medical | MN | Medicare | Online portal, Documents |
| Medicare Mississippi Part A | Medical, Dental | MS | Medicare | Online portal, Documents |
| Medicare Mississippi Part B | Medical, Dental | MS | Medicare | Online portal, Documents |
| Medicare Missouri Part A | Medical, Dental | MO | Medicare | Online portal, Documents |
| Medicare Missouri Part B | Medical, Dental | MO | Medicare | Online portal, Documents |
| Medicare Montana Part A | Medical | MT | Medicare | Online portal, Documents |
| Medicare Montana Part B | Medical, Dental | MT | Medicare | Online portal, Documents |
| Medicare Nebraska Part A | Medical | NE | Medicare | Online portal, Documents |
| Medicare Nebraska Part B | Medical, Dental | NE | Medicare | Online portal, Documents |
| Medicare Nevada Part A | Medical | NV | Medicare | Online portal, Documents |
| Medicare Nevada Part B | Medical, Dental | NV | Medicare | Online portal, Documents |
| Medicare New Hampshire Part A | Medical | NH | Medicare | Online portal, Documents |
| Medicare New Hampshire Part B | Medical, Dental | NH | Medicare | Online portal, Documents |
| Medicare New Jersey Part A | Medical | NJ | Medicare | Online portal, Documents |
| Medicare New Jersey Part B | Medical, Dental | NJ | Medicare | Online portal, Documents |
| Medicare New Mexico Part A | Medical, Dental | NM | Medicare | Online portal, Documents |
| Medicare New Mexico Part B | Medical, Dental | NM | Medicare | Online portal, Documents |
| Medicare New York Downstate | Medical, Dental | NY | Medicare | Online portal, Documents |
| Medicare New York Part A | Medical, Dental | NY | Medicare | Online portal, Documents |
| Medicare New York Part B Queens | Medical | NY | Medicare | Online portal, Documents |
| Medicare New York Part B Upstate | Medical, Dental | NY | Medicare | Online portal, Documents |
| Medicare North Carolina Part A | Medical, Dental | NC | Medicare | Online portal, Documents |
| Medicare North Carolina Part B | Medical | NC | Medicare | Online portal, Documents |
| Medicare North Dakota Part A | Medical | ND | Medicare | Online portal, Documents |
| Medicare North Dakota Part B | Medical, Dental | ND | Medicare | Online portal, Documents |
| Medicare Northern California Part A | Medical | CA | Medicare | Online portal, Documents |
| Medicare Northern California Part B | Medical, Dental | CA | Medicare | Online portal, Documents |
| Medicare Ohio Part A | Medical | OH | Medicare | Online portal, Documents |
| Medicare Ohio Part B | Medical, Dental | OH | Medicare | Online portal, Documents |
| Medicare Oklahoma Part A | Medical, Dental | OK | Medicare | Online portal, Documents |
| Medicare Oklahoma Part B | Medical, Dental | OK | Medicare | Online portal, Documents |
| Medicare Oregon Part A | Medical | OR | Medicare | Online portal, Documents |
| Medicare Oregon Part B | Medical, Dental | OR | Medicare | Online portal, Documents |
| Medicare Pennsylvania Part A | Medical, Dental | PA | Medicare | Online portal, Documents |
| Medicare Pennsylvania Part B | Medical, Dental | PA | Medicare | Online portal, Documents |
| Medicare Puerto Rico Part A | Medical | PR | Medicare | Online portal, Documents |
| Medicare Puerto Rico Part B | Medical | PR | Medicare | Online portal, Documents |
| Medicare Rhode Island Part A | Medical | RI | Medicare | Online portal, Documents |
| Medicare Rhode Island Part B | Medical, Dental | RI | Medicare | Online portal, Documents |
| Medicare South Carolina Part A | Medical, Dental | SC | Medicare | Online portal, Documents |
| Medicare South Carolina Part B | Medical, Dental | SC | Medicare | Online portal, Documents |
| Medicare South Dakota Part A | Medical | SD | Medicare | Online portal, Documents |
| Medicare South Dakota Part B | Medical, Dental | SD | Medicare | Online portal, Documents |
| Medicare Southern California Part B | Medical, Dental | CA | Medicare | Online portal, Documents |
| Medicare Tennessee Part A | Medical | TN | Medicare | Online portal, Documents |
| Medicare Tennessee Part B | Medical, Dental | TN | Medicare | Online portal, Documents |
| Medicare Texas Part A | Medical, Dental | TX | Medicare | Online portal, Documents |
| Medicare Texas Part B | Medical, Dental | TX | Medicare | Online portal, Documents |
| Medicare Utah Part A | Medical, Dental | UT | Medicare | Online portal, Documents |
| Medicare Utah Part B | Medical, Dental | UT | Medicare | Online portal, Documents |
| Medicare Vermont Part A | Medical | VT | Medicare | Online portal, Documents |
| Medicare Vermont Part B | Medical, Dental | VT | Medicare | Online portal, Documents |
| Medicare Virgin Islands Part A | Medical | VI | Medicare | Online portal, Documents |
| Medicare Virgin Islands Part B | Medical | VI | Medicare | Online portal, Documents |
| Medicare Virginia Part A | Medical, Dental | VA | Medicare | Online portal, Documents |
| Medicare Virginia Part B | Medical, Dental | VA | Medicare | Online portal, Documents |
| Medicare Washington Part B | Medical, Dental | WA | Medicare | Online portal, Documents |
| Medicare West Virginia Part A | Medical | WV | Medicare | Online portal, Documents |
| Medicare West Virginia Part B | Medical | WV | Medicare | Online portal, Documents |
| Medicare Wisconsin Part A | Medical, Dental | WI | Medicare | Online portal, Documents |
| Medicare Wisconsin Part B | Medical, Dental | WI | Medicare | Online portal, Documents |
| Medicare Wyoming Part A | Medical | WY | Medicare | Online portal, Documents |
| Medicare Wyoming Part B | Medical, Dental | WY | Medicare | Online portal, Documents |
| MedStar Family Choice District of Columbia | Medical, Dental | DC | Medicaid | Online portal |
| MedStar Family Choice Maryland | Medical, Dental | MD | Medicaid | Online portal |
| MercyCare | Medical | IL, WI | Commercial, Medicaid | Online portal |
| Meridian (Illinois) | Medical, Dental | IL | Medicaid | Online portal |
| Meridian (Michigan) | Medical, Dental, Vision | MI | Commercial, Medicaid, Medicare Advantage | Online portal |
| Meritain Health | Medical, Dental, Vision |  | Commercial | Online portal, Documents |
| Molina Complete Care Virginia DSNP | Medical, Dental | VA | Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare - Affinity by Molina Healthcare | Medical, Dental, Vision | NY | Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare - New Mexico Medicaid | Medical, Dental | NM | Medicaid | Online portal |
| Molina Healthcare California | Medical, Dental, Vision | CA | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Florida | Medical, Dental, Vision | FL | Medicaid | Online portal |
| Molina HealthCare Idaho | Medical, Vision | ID | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Illinois | Medical, Dental, Vision | IL | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Michigan | Medical, Dental, Vision | MI | Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Nebraska | Medical, Dental, Vision | NE | Medicaid, Medicare Advantage | Online portal |
| Molina HealthCare Nevada | Medical, Dental, Vision | NV | Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare New Mexico | Medical, Dental | NM | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare of Iowa | Medical, Dental, Vision | IA | Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare of Mississippi | Medical, Dental, Vision | MS | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina HealthCare Ohio | Medical, Dental, Vision | OH | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Texas | Medical, Dental, Vision | TX | Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Utah | Medical, Dental, Vision | UT | Medicaid, Medicare Advantage | Online portal |
| Molina HealthCare Washington | Medical, Dental | WA | Commercial, Medicaid, Medicare Advantage | Online portal |
| Molina Healthcare Wisconsin | Medical, Dental, Vision | WI | Medicaid | Online portal |
| Molina Ohio Medicaid Managed Care Entity | Medical, Dental, Vision | OH | Medicaid | Online portal |
| Mutual of Omaha | Medical, Dental | NE | Commercial | Online portal, Documents |
| Network Administrators | Medical |  |  | Online portal |
| Network Health Commercial | Medical, Dental, Vision | WI | Commercial, Medicare Advantage | Online portal |
| Network Health Medicare | Medical, Dental, Vision | WI | Commercial, Medicare Advantage | Online portal |
| Network Health TPA | Medical, Dental | WI | Commercial, Medicare Advantage | Online portal |
| NeueHealth | Medical |  |  | Online portal |
| Next Generation MyCare Ohio - Buckeye | Medical, Dental | OH | Medicaid, Medicare Advantage | Online portal |
| NHC Advantage | Medical | MO, SC, TN | Medicare Advantage | Online portal |
| Optum Beaver Medical Group | Medical | CA |  | Online portal |
| Optum California | Medical | CA | Commercial | Online portal |
| Optum Salt Lake County | Medical |  | Medicaid | Online portal |
| Optum San Bernardino Medical Group | Medical | CA | Commercial | Online portal |
| OSU Humana Healthy Horizons | Medical | OK | Commercial | Online portal |
| Oxford | Medical, Dental, Vision | CT, NJ, NY | Commercial | Online portal, Documents |
| PacificSource | Medical, Dental, Vision | ID, MT, OR, WA | Commercial, Medicaid, Medicare Advantage | Online portal |
| PacificSource Administrators | Medical, Dental | AL, ID, MT, OR | Commercial | Online portal |
| PacificSource Medicare | Medical, Dental | ID, MT, OR | Medicare Advantage | Online portal |
| Parkland Community Health Plan | Medical | TX | Medicaid | Online portal |
| Passport Health Plan by Molina Healthcare | Medical, Dental, Vision | KY | Medicaid | Online portal |
| Peach State Health Plan | Medical, Dental | GA | Medicaid | Online portal |
| Perennial Advantage of Ohio | Medical | OH, PA | Medicare Advantage | Online portal |
| PHP Medical | Medical | IN, OH | Commercial | Online portal |
| Planstin | Medical |  |  | Online portal |
| Preferred Provider Organization Plus LLC | Medical |  | Commercial | Online portal |
| Premera Blue Cross Alaska | Medical, Dental, Vision | AK | Commercial, Medicare | Online portal, Documents |
| Premera Blue Cross of Washington | Medical, Dental, Vision | WA | Commercial, Medicare | Online portal |
| Presbyterian Health Plan (Commercial) | Medical, Dental | NM | Commercial, Medicaid, Medicare Advantage | Online portal |
| Presbyterian Health Plan Medicaid | Medical | NM | Medicaid, Medicare Advantage | Online portal |
| Presbyterian Medicare | Medical | NM | Medicare Advantage | Online portal |
| Prominence Health Plan (Commercial) | Medical, Dental | NV | Commercial | Online portal |
| Prominence Medicare Advantage (Florida) | Medical, Dental | FL | Medicare Advantage | Online portal |
| Prominence Medicare Advantage (Nevada) | Medical, Dental | NV | Medicare Advantage | Online portal |
| Prominence Medicare Advantage (Texas) | Medical, Dental | TX | Medicare Advantage | Online portal |
| Providence Health Plan | Medical, Dental, Vision | CA, OR, WA | Commercial, Medicare Advantage | Online portal |
| Quest Behavioral Health | Medical, Dental |  |  | Online portal |
| Regence BlueCross BlueShield of Oregon | Medical, Dental, Vision | AZ, CA, ID, MT, NV, OR, UT, WA | Commercial, Medicare | Online portal, Documents |
| Regence BlueCross BlueShield of Utah | Medical, Dental, Vision | UT | Commercial, Medicare Advantage | Online portal, Documents |
| Regence BlueShield of Idaho | Medical, Dental, Vision | ID, WA | Commercial, Medicare Advantage | Online portal, Documents |
| Regence BlueShield of Washington | Medical, Dental, Vision | WA | Commercial, Medicare Advantage | Online portal, Documents |
| Salia Healthcare | Medical |  |  | Online portal |
| Sana Benefits | Medical, Dental, Vision | AL, AZ, CO, DE, IL, IN, IA, KS, KY, MD, MA, MI, OH, OK, PA, TX, VA, WI | Commercial | Online portal |
| Sanford Health Plan | Medical | IA, MN, NE, ND, SD | Commercial, Medicare Advantage | Online portal |
| Sanford Health Plan Medicare Advantage | Medical, Dental | IA, MN, NE, ND, SD | Medicare Advantage | Online portal |
| Santa Clara County | Medical |  | Medicaid, Medicare Advantage | Online portal |
| SCAN Health Plan | Medical, Dental, Vision | AZ, CA, NV, NM, TX, WA | Medicaid, Medicare Advantage | Online portal |
| Senior Whole Health | Medical, Dental | ID, MA, NV, NY | Medicaid, Medicare Advantage | Online portal |
| Senior Whole Health of New York | Medical, Dental, Vision | NY | Medicaid, Medicare Advantage | Online portal |
| Sentara Health Plans | Medical, Dental | VA | Commercial, Medicaid, Medicare Advantage | Online portal |
| Shared Health Mississippi | Medical, Dental | MS | Medicaid, Medicare Advantage | Online portal, Documents |
| Simply Healthcare | Medical, Vision | FL | Medicaid, Medicare Advantage | Online portal, Documents |
| Student Resources (UnitedHealthcare) | Medical, Dental |  | Commercial | Online portal, Documents |
| Summit Community Care | Medical | AR | Medicaid | Online portal |
| Surest | Medical, Dental, Vision | Nationwide | Commercial | Online portal, Documents |
| TLC Benefit Solutions | Medical, Dental |  | Commercial | Online portal |
| TRICARE for Life | Medical, Dental | Nationwide | TRICARE | Online portal, Documents |
| UFCW Local 1262 Welfare Dental Program | Dental | NJ, NY | Commercial | Online portal, Documents |
| UMR | Medical, Dental, Vision | Nationwide | Commercial | Online portal, Documents |
| United American Insurance Company | Medical | GA, NJ, NC, OK, SC, TN, WV, WY | Medicare | Online portal, Documents |
| United HealthCare Community Plan Missouri | Medical, Dental, Vision | MO | Medicaid | Online portal |
| United HealthCare Community Plan of Arizona | Medical, Dental, Vision | AZ | Medicaid | Online portal |
| United HealthCare Ohio Medicaid Managed Care Entity (MCE) | Medical, Dental, Vision | OH | Medicaid | Online portal |
| UnitedHealthcare | Medical, Dental, Vision | GU, Nationwide | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| UnitedHealthcare Community Plan | Medical, Dental, Vision | AZ, CO, FL, HI, ID, IN, KS, KY, LA, MD, MI, MN, MS, MO, NE, NV, NJ, NM, NY, NC, OH, PA, RI, TN, TX, VA, WA, WI | Medicaid, Medicare Advantage | Online portal, Documents |
| UnitedHealthcare Community Plan - KS (KanCare) | Medical, Dental, Vision | KS | Medicaid | Online portal |
| UnitedHealthcare Community Plan - Michigan, Utah | Medical, Dental, Vision | MI | Medicaid, Medicare Advantage | Online portal, Documents |
| UnitedHealthcare Community Plan New Jersey | Medical, Dental, Vision | NJ | Medicaid | Online portal |
| Unitedhealthcare Community Plan New Mexico Medicaid | Medical, Dental, Vision | NM | Medicaid | Online portal |
| UnitedHealthcare Community Plan of Pennsylvania | Medical | PA | Medicaid | Online portal |
| UnitedHealthcare Community Plan Tennessee | Medical, Dental, Vision | TN | Medicaid | Online portal |
| UPMC Health Plan | Medical, Dental, Vision | OH, PA | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Veterans Affairs Community Care Network (Optum Serve) | Medical, Dental, Vision | Nationwide | Veterans Affairs | Online portal, Documents |
| Washington National | Medical |  |  | Online portal |
| WebTPA | Medical, Dental, Vision | Nationwide | Commercial |  |
| Wellcare | Medical, Dental, Vision | Nationwide | Medicaid, Medicare Advantage |  |
| WellCare (Encounters) | Medical, Dental, Vision | Nationwide | Medicare Advantage | Online portal |
| Wellmark | Medical, Dental, Vision | IA, SD | Commercial, Medicare Advantage | Online portal, Documents |
| Wellpoint | Medical, Dental, Vision | AZ, IA, NJ, TN, TX, WA | Commercial, Medicaid, Medicare | Online portal, Documents |
| Wellpoint West Virginia | Medical, Dental, Vision | WV | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Western & Southern Financial Group | Medical |  | Commercial | Online portal |
| WPS – Family Care (FAMC) | Medical | WI | Commercial | Online portal, Documents |
| WPS (WPS-TMEP) | Medical | Nationwide | Medicare | Online portal, Documents |
| WPS Health Insurance | Medical, Dental, Vision | WI | Commercial | Online portal |
| WPS Health Plan | Medical, Dental, Vision | IL, WI | Commercial, Medicare | Online portal |
| Zing Health | Medical, Dental | IL, IN, MI, MS, OH, TN | Medicare Advantage | Online portal |
| Alliance Health | Medical, Dental, Vision | NC | Medicaid | Form |
| AmeriHealth Administrators | Medical, Dental, Vision |  | Commercial | Online portal |
| Ameritas | Dental | Nationwide | Commercial | Online portal |
| Ameritas | Dental | Nationwide | Commercial | Online portal |
| AmTrust North America | Medical |  | Workers' Compensation | Online portal |
| Anthem Blue Cross Blue Shield (Ohio Medicaid) | Medical, Dental, Vision | OH | Medicaid | Online portal |
| Anthem Blue Cross Blue Shield Dental | Dental, Vision | CO, GA, KS, KY, ME, MO, NH, NY, OH, VA, WI | Commercial, Medicaid | Online portal |
| AultCare | Medical, Dental, Vision | OH | Commercial, Medicare, Medicare Advantage, Workers' Compensation | Phone |
| AZ Blue | Medical, Dental, Vision | AZ | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| Blue Cross & Blue Shield of Rhode Island | Medical, Dental, Vision | FL, MA, RI | Commercial, Medicare Advantage | Form |
| Blue Cross and Blue Shield of Kansas City | Medical, Dental, Vision | MO | Commercial, Medicare | Form |
| Blue Cross and Blue Shield of Mississippi | Medical, Dental, Vision | MS | Commercial, Medicare Advantage | Online portal |
| Blue Cross and Blue Shield of Vermont | Medical, Dental, Vision | VT | Commercial, Medicare | Phone |
| Blue Cross NC | Medical, Dental, Vision | NC | Commercial, Medicaid, Medicare Advantage | Online portal |
| Blue Cross of Idaho | Medical, Dental, Vision | ID | Commercial, Medicaid, Medicare Advantage | Online portal |
| Blue Shield of California | Medical, Dental, Vision | AZ, CA, HI, ID, MT, NV, OR, SD, TX, UT, WA | Commercial, Medicaid, Medicare | Online portal |
| BlueCross BlueShield of Alabama | Medical, Dental, Vision | AL | Commercial, Medicare Advantage | Online portal, Documents |
| BlueCross BlueShield of South Carolina | Medical, Dental, Vision | SC | Commercial, Medicare Advantage | Form |
| CalOptima | Medical, Dental | CA | Medicaid, Medicare Advantage | Online portal |
| CareFirst BlueCross BlueShield District of Columbia (NCA) | Medical, Dental, Vision | GA, DC | Commercial, Medicaid, Medicare Advantage | Online portal, Documents |
| CareFirst Medicare Advantage | Medical, Dental, Vision | MD, DC, VA | Medicare Advantage | Online portal |
| CHAMPVA | Medical, Dental, Vision | Nationwide | Veterans Affairs | Phone |
| Cigna Medicare Supplement | Medical | Nationwide | Medicare | Online portal |
| Cigna Medicare Supplement (Medigap) | Medical, Dental |  | Commercial | Online portal |
| Colonial Penn Life | Medical | AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY, DC | Medicare | Online portal, Documents |
| ConnectiCare | Medical, Dental, Vision | CT | Medicare | Online portal |
| Davis Vision | Medical, Vision | Nationwide |  | Online portal |
| Dean Health Plan | Medical, Dental | WI | Commercial, Medicare Advantage | Online portal |
| DentaQuest - Group | Dental | Nationwide | Commercial | Online portal |
| DentaQuest - Individual | Dental | TN | Medicaid | Online portal |
| EmblemHealth Plan | Medical, Dental, Vision | NY | Commercial, Medicaid, Medicare Advantage | Online portal |
| EMI Health | Medical, Dental, Vision | Nationwide | Commercial | Form |
| Empower Healthcare Solutions | Medical | AR | Medicaid | Online portal |
| Excellus BlueCross BlueShield | Medical, Dental, Vision | NY | Commercial, Medicare Advantage | Online portal |
| Farm Bureau Health Plans | Medical, Dental, Vision | TN | Commercial, Medicare | Online portal |
| Fidelis Care | Medical, Dental | NY | Commercial, Medicaid, Medicare Advantage | Online portal |
| First Choice by Select Health South Carolina - Medicaid | Medical, Dental | SC | Medicaid | Online portal |
| First Choice Next | Medical | SC | Commercial | Online portal |
| First Choice VIP Care - Medicare Advantage (D-SNP) | Medical | SC | Medicaid, Medicare Advantage | Online portal |
| First Choice VIP Care Plus - Medicare and Medicaid | Medical | SC | Medicaid, Medicare Advantage | Online portal |
| Guardian | Medical, Dental, Vision | Nationwide | Commercial | Online portal |
| HeadsUp Healthcare | Medical, Dental |  | Workers' Compensation | Online portal |
| Health First Colorado | Medical, Dental, Vision | CO | Medicaid | Online portal, Documents |
| Health Plan of San Joaquin | Medical | CA | Medicaid | Online portal |
| HIP / EmblemHealth Insurance Company | Medical, Dental, Vision | NY | Commercial, Medicaid, Medicare Advantage | Online portal |
| HIP / EmblemHealth Insurance Company (GHI HMO) | Medical, Dental | NY | Commercial, Medicaid, Medicare Advantage | Online portal |
| HIP / EmblemHealth Insurance Company (Vytra HMO) | Medical | NY | Commercial, Medicaid, Medicare Advantage | Online portal |
| Hometown Health | Medical | NV | Commercial, Medicare Advantage | Online portal |
| iCare | Medical | WI | Medicaid, Medicare Advantage | Online portal |
| Inland Empire Health Plan | Medical, Dental | CA | Medicaid, Medicare Advantage | Form |
| InnovAge | Medical | CA, CO, NM, PA, VA | Medicaid, Medicare | Online portal |
| InterCommunity Health Network CCO | Medical, Dental, Vision | OR | Medicaid | Online portal |
| Keystone First | Medical | PA | Medicaid | Form |
| Keystone First CHIP | Medical, Dental | PA | Medicaid | Form |
| Keystone First Community HealthChoices | Medical | PA | Medicaid, Medicare | Form |
| Keystone First VIP Choice | Medical, Dental | PA | Medicaid, Medicare Advantage | Form |
| Louisiana Blue | Medical, Dental, Vision | LA | Commercial, Medicaid, Medicare Advantage | Form |
| MagnaCare | Medical, Dental | NJ, NY | Commercial | Form |
| Maryland Physicians Care | Medical | MD | Medicaid | Online portal |
| Medica | Medical, Dental, Vision | AZ, IA, KS, MN, MO, NE, ND, OK, SD, WI, WY | Commercial, Medicaid, Medicare Advantage | Online portal |
| Medicaid Alabama | Medical, Dental, Vision | AL | Medicaid | Online portal |
| Medicaid Arkansas | Medical, Dental, Vision | AR | Medicaid | Online portal |
| Medicaid California Medi-Cal | Medical, Dental | CA | Medicaid | Online portal |
| Medicaid Connecticut | Medical, Dental, Vision | CT | Medicaid | Online portal |
| Medicaid Georgia | Medical, Dental | GA | Medicaid | Form |
| Medicaid Kentucky | Medical, Dental | KY | Medicaid | Online portal |
| Medicaid Nevada | Medical, Dental | NV | Medicaid | Form |
| Medicaid New Mexico | Medical, Dental, Vision | NM | Medicaid | Online portal |
| Medicaid Ohio | Medical, Dental, Vision | OH | Medicaid | Online portal |
| Medicaid South Carolina | Medical, Dental | SC | Medicaid | Form |
| Medicaid Texas - Acute | Medical, Dental, Vision | TX | Medicaid | Online portal, Documents |
| Medicaid Texas - CHIP | Medical, Dental, Vision | TX | Medicaid | Online portal, Documents |
| Medicaid Texas (Long Term Care) | Medical, Dental | TX | Medicaid | Online portal, Documents |
| Medicaid Utah | Medical, Dental | UT | Medicaid | Online portal |
| Medicaid Vermont | Medical, Dental, Vision | VT | Medicaid | Form |
| Medicaid Washington | Medical, Dental | WA | Medicaid | Online portal |
| Medical Associates Health Plans | Medical, Dental | IL, IA, WI | Commercial, Medicare Advantage | Online portal |
| Medicare Railroad | Medical, Dental | Nationwide | Medicare | Form |
| Mercy Care ACC-RBHA | Medical, Dental | AZ | Medicaid, Medicare Advantage | Documents, Form |
| Mercy Care Arizona | Medical, Dental, Vision | AZ | Medicaid, Medicare Advantage | Documents, Form |
| Mercy Care Plan (AZ Health Care Cost Containment System) | Medical, Dental, Vision | AZ | Medicaid, Medicare Advantage | Documents, Form |
| MetLife Dental Family | Dental | Nationwide |  | Online portal |
| Northwest IAM Trust | Medical |  | Commercial | Online portal |
| Physicians Health Plan (PHP) of Northern Indiana | Medical, Dental, Vision | IN | Commercial | Online portal |
| Samaritan Advantage | Medical | OR | Medicare Advantage | Online portal |
| Samaritan Employer Group | Medical | OR | Commercial | Online portal |
| SAMBA | Medical, Dental, Vision |  | Commercial | Form |
| Santa Clara Family Health Plan | Medical | CA | Medicaid | Online portal |
| Select Health | Medical, Dental, Vision | ID, NV, UT | Commercial, Medicaid, Medicare Advantage | Online portal |
| Shiawassee Health & Wellness (Michigan) | Medical | MI | Medicaid | Phone |
| Sun Life | Dental | Nationwide | Commercial | Online portal |
| Sutter Health Plan | Medical, Dental | CA | Commercial | Online portal |
| TRICARE East | Medical, Dental, Vision | AL, AR, CT, DE, FL, GA, IL, IN, IA, KY, LA, ME, MD, MA, MI, MS, MO, NH, NJ, NY, NC, OH, OK, PA, RI, SC, TN, TX, VT, VA, WV, WI, DC | TRICARE | Online portal |
| Triple-S Salud (Commercial and Medicaid) | Medical, Dental | PR | Commercial, Medicaid, Medicare Advantage | Form |
| Triple-S Salud (Medicare Advantage) | Medical, Dental | PR | Medicare Advantage | Form |
| UMWA Health and Retirement Funds | Medical, Dental, Vision | Nationwide | Commercial | Online portal |
| UnitedHealthcare Dental | Dental, Vision | Nationwide | Commercial | Online portal |
| Univera Healthcare | Medical, Vision | NY | Commercial, Medicaid, Medicare Advantage | Online portal |
| Vaya Health | Medical, Dental, Vision | NC | Medicaid | Form |
| Westfield Insurance | Medical | Nationwide |  | Online portal |
| WPAS | Medical, Dental |  | Commercial | Online portal |
| 11 Med Funding | Medical |  |  |  |
| 1199SEIU National Benefit Fund | Medical, Dental |  | Commercial |  |
| 20/20 Eye Care Network | Medical, Vision |  | Commercial |  |
| 22 Health Community Care Plan | Medical | FL | Commercial |  |
| 5Star Life Insurance Company | Medical |  | Commercial |  |
| 6 Degrees Health | Medical, Dental |  | Commercial |  |
| A-G Specialty Insurance | Medical |  | Commercial |  |
| AAA Minnesota Iowa | Medical |  |  |  |
| AARP Dental Insurance Plan | Dental | Nationwide | Commercial |  |
| Abilis Health Plan | Medical | KY, TN | Medicare Advantage |  |
| AblePay Health | Medical |  | Commercial |  |
| Acadia Insurance Company | Medical | CT, ME, MA, NH, NY, RI, VT | Workers' Compensation |  |
| Accelerated Claims Inc | Medical |  |  |  |
| Access Behavioral Health | Medical | FL | Medicaid |  |
| Access Community Health Network | Medical | IL |  |  |
| Access Independent Practice Association | Medical | CA | Commercial |  |
| Access Medical Group | Medical | CA |  |  |
| Access to Care Health Plan | Medical | TX | Commercial |  |
| Acclaim Healthcare Management | Medical |  | Commercial |  |
| Accountable Health Care IPA | Medical | CA | Commercial |  |
| Accountable Healthcare Independent Physician Association (AHIPA) | Medical | CA |  |  |
| ACE Medicare Supplement | Medical, Vision |  | Medicare |  |
| ACI | Medical, Dental, Vision |  | Commercial |  |
| ACMG Benefit Administrators | Medical | VA | Commercial |  |
| ACS Benefit Services | Medical, Dental, Vision | NC | Commercial |  |
| Active Care Inc. (Valenz) | Medical |  | Commercial |  |
| ActivHealthCare | Medical | GA | Commercial |  |
| ADL Risk Services | Medical |  |  |  |
| Administración de Compensaciones por Accidentes de Automóviles | Medical | PR | Automobile medical |  |
| Administrative District Council 1 Welfare fund | Dental | IL | Commercial |  |
| Administrative Services Only | Medical, Dental |  | Commercial |  |
| AdminOne | Medical |  | Commercial |  |
| ADOC Medical Group | Medical | CA | Commercial |  |
| Advanced Health | Medical, Dental, Vision | OR | Medicaid |  |
| Advanced Medical Doctors Of California | Medical | CA | Commercial |  |
| Advantage by Managed Health Services | Medical | WI | Commercial, Medicaid, Medicare Advantage |  |
| Advantage Care IPA | Medical | CA | Commercial |  |
| Advantage Dental | Dental | OR | Medicaid |  |
| Advantek Benefit Administrators | Medical |  | Commercial |  |
| Advent Health Medical Corporation | Medical | CA | Commercial |  |
| AdventHealth | Medical | CO, FL, GA, IL, KS, KY, NC, TX, WI |  |  |
| AdventHealth Transplant Program | Medical | CO, FL |  |  |
| AdventHealth Value Based Bundle Management, LLC | Medical | CO, FL, GA, IL, KS, KY, NC, TX, WI |  |  |
| Adventist Health Employee Health Plan | Medical, Dental |  |  |  |
| Adventist Health Plan | Medical | CA | Commercial |  |
| Adventist Health Plan Provider Network | Medical |  | Commercial |  |
| Adventist White Memorial (Crown City Medical Group) | Medical | CA |  |  |
| Advisory Health Administrators | Medical, Dental |  | Commercial |  |
| Advocare MCO Incorporated | Medical | OH | Workers' Compensation |  |
| Advocate Physician Partners | Medical | IL |  |  |
| Aegis Administrative Services | Medical | AL, FL, GA, MS, NC, SC, TN, VA | Commercial |  |
| Aetna DMO | Medical, Dental, Vision |  | Commercial |  |
| Aetna EAP | Medical |  | Commercial |  |
| Aetna Retiree Medical Plan - Administrator | Medical, Dental, Vision |  | Commercial |  |
| Aetna Senior Supplemental | Medical, Dental, Vision |  | Medicare |  |
| Aetna Senior Supplemental Insurance | Medical, Dental | Nationwide | Medicare |  |
| Aetna Voluntary Plans | Medical, Dental, Vision |  | Medicare |  |
| Affiliated Partners IPA | Medical | CA | Commercial |  |
| Affiliated Physicians IPA | Medical | CA | Commercial |  |
| Affinity Medical Group | Medical | CA | Commercial |  |
| Aflac Medicare Supplemental | Medical |  | Medicare |  |
| AgeRight Advantage | Medical | OR, WA | Medicare Advantage |  |
| AHCN - SCAN Hanford | Medical | CA |  |  |
| AHCN - SCAN White | Medical | CA |  |  |
| AHS Plans | Medical | Nationwide | Commercial |  |
| AIDS Healthcare Foundation | Medical |  |  |  |
| AIG Chartis | Medical |  | Workers' Compensation |  |
| Aither Health | Medical |  | Commercial |  |
| Alameda Alliance for Health | Medical, Vision | CA | Medicaid |  |
| Albuquerque Public Schools | Medical | NM | Commercial |  |
| Align Network (One Call Physical Therapy) | Medical |  |  |  |
| Align Senior Care of California | Medical | CA | Medicare Advantage |  |
| Align Senior Care of Florida | Medical | FL | Medicare Advantage |  |
| Align Senior Care of Michigan | Medical | MI | Medicare Advantage |  |
| Align Senior Care of Virginia | Medical | VA | Medicare Advantage |  |
| Aligned Community Physicians | Medical | CA | Commercial |  |
| Alivi Health | Medical |  |  |  |
| Alivi Therapy Network | Medical | PR | Commercial |  |
| All Savers | Medical, Dental, Vision |  | Commercial |  |
| All Smiles Community Oral Health | Medical, Dental | OR |  |  |
| All United Medical Group | Medical | CA | Commercial |  |
| AllCare Advantage | Medical | OR | Medicare Advantage |  |
| AllCare Health CCO | Medical, Dental | OR | Medicaid |  |
| AllCare IPA | Medical | CA | Commercial |  |
| Allegeant | Medical |  | Commercial |  |
| Alliance Alpha Care Gold | Medical |  | Commercial |  |
| Alliance Coal Health Plan | Medical, Dental |  | Commercial |  |
| Alliant | Medical, Dental | GA | Commercial |  |
| Alliant Health Plans | Medical, Dental | GA | Commercial |  |
| Allianz | Medical |  | Commercial |  |
| Allianz Global Assistance | Medical |  |  |  |
| Allianz of America, Inc. – Workers Compensation | Medical |  | Workers' Compensation |  |
| Allied Benefit Systems | Medical, Dental, Vision | Nationwide | Commercial |  |
| Allina Health Aetna | Medical, Dental, Vision | MN | Commercial |  |
| Allstate (All States Except New Jersey) | Medical | Nationwide |  |  |
| Allstate Benefits | Medical, Dental, Vision |  |  |  |
| Allstate Health Solutions | Medical, Dental |  | Commercial |  |
| AlohaCare | Medical, Dental, Vision | HI | Medicaid, Medicare Advantage |  |
| Alpha Care Medical Group (Astrana Health) | Medical | CA | Commercial |  |
| Altais | Medical, Vision | CA | Commercial |  |
| Altais Care Network | Medical |  |  |  |
| AltaMed | Medical, Dental | CA | Medicaid |  |
| Alternative Insurance Resources | Medical |  | Commercial |  |
| Alternative Insurance Resources | Medical, Vision | AL | Commercial |  |
| Alternative Risk Management (ARM) | Medical | IL, OR | Commercial |  |
| Altura Management Services | Medical |  | Commercial |  |
| Altus Dental | Dental | MA, RI | Commercial |  |
| Amada Health (Fresno and Madera County) | Medical | CA | Medicare |  |
| Amada Health (Los Angeles and Orange County) | Medical | CA | Medicare |  |
| Amada Health Alameda | Medical | CA |  |  |
| Amalgamated Employee Benefits Administrators | Medical |  | Commercial |  |
| AmeriBen | Medical | AZ | Commercial |  |
| AmeriBen | Medical, Dental |  | Commercial |  |
| America's Choice Healthplans | Medical |  | Commercial |  |
| American Behavioral | Medical |  | Commercial |  |
| American Benefit Corporation | Medical |  | Commercial |  |
| American Correctional Healthcare | Medical |  |  |  |
| American Family Insurance Company | Medical, Dental |  |  |  |
| American Family Insurance Group | Medical |  |  |  |
| American Fidelity | Medical, Dental | DC, NY | Commercial |  |
| American Health Advantage of Florida | Medical | FL | Medicare Advantage |  |
| American Health Advantage of Idaho / Utah | Medical | ID | Medicare Advantage |  |
| American Health Advantage of Indiana | Medical, Vision | IN | Medicare Advantage |  |
| American Health Advantage of Louisiana | Medical, Vision | LA | Medicare Advantage |  |
| American Health Advantage of Mississippi | Medical, Vision | MS | Medicare Advantage |  |
| American Health Advantage of Missouri | Medical, Vision | MO | Medicare Advantage |  |
| American Health Advantage of Oklahoma | Medical, Vision | OK | Medicare Advantage |  |
| American Health Advantage of Pennsylvania | Medical | PA | Medicare Advantage |  |
| American Health Advantage of Tennessee | Medical | TN | Medicare Advantage |  |
| American Health Advantage of Texas | Medical | TX | Medicare Advantage |  |
| American Health Plans of Pennsylvannia | Medical | PA | Medicare Advantage |  |
| American Health Resources | Medical |  | Commercial |  |
| American Healthcare Alliance | Medical |  | Commercial |  |
| American Insurance Company of Texas | Medical |  |  |  |
| American Medical Association Insurance Agency | Medical |  | Medicare |  |
| American National | Medical | Nationwide | Medicare |  |
| American National Insurance Company | Medical | Nationwide | Medicare |  |
| American National Property and Casualty Company | Medical |  |  |  |
| American Plan Administrators | Medical |  | Commercial |  |
| American Republic Insurance Company | Medical, Dental, Vision |  | Medicare |  |
| American Specialty Health | Medical | Nationwide | Commercial |  |
| American Therapy Administrators | Medical |  | Commercial |  |
| American Worker Health Plus | Medical |  | Commercial |  |
| Americo Financial Life and Annuity Insurance Company | Medical, Vision |  | Medicare |  |
| Amerigroup | Medical, Vision |  | Medicaid |  |
| Ameriprise Auto and Home Insurance | Medical |  |  |  |
| Amerisafe Risk Services Incorporated | Medical |  | Workers' Compensation |  |
| Ameritas Dental First Reliance Standard Life | Dental | Nationwide |  |  |
| Ameritas Group - Standard Insurance | Dental | Nationwide |  |  |
| Ameritas Life Insurance Corporation | Dental | Nationwide |  |  |
| AmFirst Insurance | Medical | DC |  |  |
| AmGuard Insurance Company Doing Business As (DBA) Guard | Medical | Nationwide | Commercial |  |
| AmGuard Insurance Company Guard DBA | Medical |  | Workers' Compensation |  |
| Amica Mutual Insurance Company | Medical |  |  |  |
| Amida Care | Medical | NY | Medicaid |  |
| Amwins Connect | Medical, Dental |  | Commercial |  |
| Anchor Benefit Consulting | Medical |  | Commercial |  |
| Angle Health | Medical | UT | Commercial |  |
| Antelope Valley Medical Associates (Regal) | Medical | CA | Commercial |  |
| Anthem Blue Cross and Blue Shield HP | Medical, Dental, Vision | CO, GA, KS, KY, ME, MO, NH, NY, OH, VA, WI | Commercial, Medicaid |  |
| Anthem Blue Cross and Blue Shield MyCare Ohio | Medical, Dental, Vision | OH | Medicaid, Medicare Advantage |  |
| Anthem CareMore | Medical, Dental, Vision | AZ, CA, NV, TN | Medicaid, Medicare Advantage |  |
| Anthem EAP | Medical |  | Commercial |  |
| Anthem Ohio Medicaid Vision | Medical, Vision | OH | Medicaid |  |
| Antidote Health Plan of Arizona | Medical | AZ | Commercial |  |
| Apex Health Solutions  | Medical | OH | Commercial |  |
| ApolloCare Partners of Nevada | Medical | NV |  |  |
| APS Healthcare Puerto Rico Inc | Medical | PR |  |  |
| Apta Health | Medical, Dental |  | Commercial |  |
| APWUHP | Medical, Dental, Vision | Nationwide | Commercial, Medicare Advantage |  |
| Aradigm | Medical |  |  |  |
| ArchCare Senior Life | Medical, Dental | NY | Medicaid, Medicare |  |
| Argonaut Insurance Company (Argo) | Medical |  | Workers' Compensation |  |
| Arizona Priority Care | Medical | AZ |  |  |
| Arlo | Medical |  | Commercial |  |
| ArmadaCare | Medical |  | Commercial |  |
| Array Health | Medical, Dental |  | Commercial |  |
| Arrowhead Regional Medical Center | Medical | CA |  |  |
| Ascension Care Partners Illinois | Medical | IL | Commercial |  |
| Ascension Living Alexian PACE | Medical | TN | Medicaid, Medicare |  |
| Ascension Living Hope PACE | Medical | MI | Medicaid, Medicare Advantage |  |
| Ascension Living PACE Michigan | Medical | MI | Medicaid, Medicare Advantage |  |
| Ascension Living St. Vincent PACE Incorporated | Medical | IN | Medicaid, Medicare Advantage |  |
| Aspire Health Plan | Medical | CA | Medicare Advantage |  |
| Aspirus Health Plan - Commercial | Medical, Vision | WI | Commercial, Medicare Advantage |  |
| Aspirus Medicare Advantage | Medical | WI | Medicare Advantage |  |
| ASR Health Benefits | Medical, Dental, Vision | MI, OH | Commercial |  |
| ASRM | Medical |  | Commercial |  |
| Assist Health Group Inc | Medical | Nationwide | Commercial |  |
| Associated Hispanic Physicians Southern California | Medical | CA | Commercial |  |
| Associates for Health Care Incorporated (Claritev) | Medical |  | Commercial, Medicaid, Medicare Advantage |  |
| Assured Benefits Administrators | Medical |  | Commercial |  |
| Assured Benefits Administrators | Medical |  | Commercial |  |
| Astiva Health | Medical, Dental | CA | Medicare |  |
| Astrana Health | Medical | CA, NV, TX | Commercial |  |
| Astrana Health | Medical | CA | Commercial |  |
| Asuris Northwest Health | Medical, Dental, Vision | WA | Commercial, Medicare Advantage |  |
| Athens | Medical |  | Workers' Compensation |  |
| Atheria | Medical |  | Commercial |  |
| Atlas Life Insurance Company | Medical |  | Medicare |  |
| AudioNet - National Elevator | Medical |  |  |  |
| AudioNet America | Medical |  | Medicaid, Medicare Advantage |  |
| AudioNet UAW Ford Retirees GM Employees | Medical |  |  |  |
| AudioNet UAW GM Retirees | Medical |  |  |  |
| Austin Regional Clinic Employee Benefit Plan | Medical | TX | Commercial |  |
| Auto-Owners Homeowners Insurance Company | Medical | AL, AZ, AR, CO, FL, GA, ID, IL, IN, IA, KS, KY, MI, MN, MO, NE, NC, ND, OH, PA, SC, SD, TN, UT, VA, WI |  |  |
| Auto-Owners Insurance | Medical | AL, AZ, AR, CO, FL, GA, ID, IL, IN, IA, KS, KY, MI, MN, MO, NE, NC, ND, OH, PA, SC, SD, TN, UT, VA, WI | Workers' Compensation |  |
| Auto-Owners Insurance Company | Medical | AL, AZ, AR, CO, FL, GA, ID, IL, IN, IA, KS, KY, MI, MN, MO, NE, NC, ND, OH, PA, SC, SD, TN, UT, VA, WI |  |  |
| Auto-Owners Life Insurance Company | Medical | AL, AR, AZ, CO, FL, GA, IA, ID, IL, IN, KS, KY, MA, ME, MI, MN, MO, NC, ND, NE, NH, OH, PA, SC, SD, TN, UT, VA, VT, WI |  |  |
| Auto-Owners Property Owners Insurance Company | Medical | AL, AZ, AR, CO, FL, GA, ID, IL, IN, IA, KS, KY, MI, MN, MO, NE, NC, ND, OH, PA, SC, SD, TN, UT, VA, WI |  |  |
| Auto-Owners Southern-Owners Company | Medical | MN |  |  |
| Automated Benefit Services | Medical, Dental |  | Commercial |  |
| Automated Group Administration | Medical |  | Commercial |  |
| Auxiant | Medical, Dental, Vision |  | Commercial |  |
| Auxiant (Valenz) | Medical |  | Commercial |  |
| Auxilio Plan de Socios | Medical | PR |  |  |
| Auxilio Salud Plus Inc | Medical, Dental, Vision | PR | Commercial |  |
| Avalon Healthcare Solutions (Capital Blue Cross) | Medical |  |  |  |
| Avalon Healthcare Solutions (North Carolina) | Medical |  |  |  |
| Avalon Healthcare Solutions (South Carolina) | Medical |  |  |  |
| Avalon Healthcare Solutions (Vermont) | Medical | Nationwide |  |  |
| Avant Health Incorporated | Medical | CA | Commercial |  |
| Avente Health Solutions | Medical | CA |  |  |
| Avera Health Plans | Medical, Dental | IA, NE, SD | Commercial |  |
| Avēsis | Dental |  | Commercial |  |
| Avesis Insurance Incorporated | Medical, Dental |  | Commercial, Medicaid |  |
| AvMed | Medical, Vision | FL | Commercial |  |
| B&C Trust Funds | Medical |  | Commercial |  |
| BAI | Medical |  | Commercial |  |
| Bakersfield Family Medical Center | Medical | CA | Commercial, Medicare Advantage |  |
| Bankers Fidelity Life Insurance Company | Medical | AL, AZ, AR, CO, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, MD, MI, MS, MO, MT, NE, NV, NJ, NM, NC, ND, OH, OK, PA, SC, SD, TN, TX, UT, VA, WV, WY, DC, PR | Medicare |  |
| Banner – University Family Care/Arizona Long Term Care | Medical | AZ | Medicaid |  |
| Banner \| Aetna | Medical, Dental | AZ | Commercial |  |
| Baptist Heart Institute | Medical | FL | Commercial |  |
| Baptist Hospital South Florida International | Medical |  |  |  |
| Bardavon Health Innovations | Medical | Nationwide |  |  |
| BAS | Medical |  | Commercial |  |
| Basil Castrovinci Associates | Medical, Dental | NJ | Commercial |  |
| Bay Area Care Partners | Medical | CA | Commercial |  |
| Bay Bridge Administrators LLC | Medical | TX | Commercial |  |
| BayCare Health Plans | Medical, Vision | FL | Medicare Advantage |  |
| Baylor Scott and White Health Plan | Medical, Dental, Vision | TX | Commercial, Medicare Advantage |  |
| BCBS Michigan Medicare Plus Blue PPO (KC) - JVHL | Medical | MI | Medicare Advantage |  |
| BCBS Wyoming Medicare Advantage | Medical | WY | Medicare Advantage |  |
| Beam | Dental |  | Commercial |  |
| Bella Vista Medical Group | Medical |  |  |  |
| Benchmark Insurance | Medical |  | Workers' Compensation |  |
| Benefit Coordinators Corporation (Pittsburgh PA) | Medical | PA | Commercial |  |
| Benefit Health Plan | Medical |  | Commercial |  |
| Benefit Management Incorporated | Medical |  | Commercial, Medicaid, Medicare Advantage |  |
| Benefit Plan Administrators | Medical | CA, NV | Commercial |  |
| Benefit Plan Administrators (Roanoke Virginia) | Medical | VA | Commercial |  |
| Benefit Plan Administrators Company (Eau Claire Wisconsin) | Medical, Dental | Nationwide | Commercial |  |
| Benefit Support | Medical | Nationwide | Commercial |  |
| benefitSMART | Medical |  | Commercial |  |
| BeneSys | Medical |  | Commercial |  |
| BeniComp IncentiCare | Medical |  | Commercial |  |
| Berkley Entertainment  | Medical |  |  |  |
| Berkley Specialty Underwriters | Medical |  | Commercial, Medicaid, Medicare Advantage |  |
| Berkshire Hathaway Homestate Companies | Medical | DC, IA | Commercial |  |
| Best Doctors Insurance | Medical |  | Commercial |  |
| Best Life and Health Insurance Company | Medical, Dental, Vision | Nationwide | Commercial |  |
| Beverly Hospital | Medical |  |  |  |
| Bienvivir | Medical | TX | Medicaid |  |
| Blackhawk Claims Service | Medical |  | Commercial |  |
| Block Vision Eye Specialists (Versant Health) | Medical, Vision | Nationwide | Commercial |  |
| Blue Advantage | Medical, Dental | LA | Medicare |  |
| Blue Care Network - BCN Commercial Labs (JJ) - JVHL | Medical | MI | Commercial |  |
| Blue Cross Blue Shield Louisiana Blue Advantage | Medical, Dental, Vision | LA | Medicare Advantage |  |
| Blue Cross Blue Shield of Arizona Health Choice | Medical, Dental, Vision | AZ | Medicaid |  |
| Blue Cross Blue Shield of Arizona Health Choice Pathway | Medical, Dental | AZ | Medicaid, Medicare Advantage |  |
| Blue Cross Blue Shield of Minnesota Blue Plus Medicaid | Medical, Dental | MN | Commercial, Medicaid |  |
| Blue Cross Blue Shield Pennsylvania BlueCard Par Point Services (POS) | Medical, Dental, Vision | PA |  |  |
| Blue Cross Blue Shield Preferred Health Professionals (BCBSKC) | Medical | KS, MO | Commercial |  |
| Blue Cross Blue Shield State and School Employees | Medical, Dental, Vision | MS | Commercial |  |
| Blue Cross Community Centennial | Medical, Vision | NM | Medicaid |  |
| Blue Cross Complete (KP) - JVHL | Medical |  | Commercial, Medicaid, Medicare Advantage |  |
| Blue Cross Idaho (True Blue) | Medical | ID | Commercial, Medicare Advantage |  |
| Blue Cross Medicare Advantage | Medical, Dental, Vision | Nationwide | Medicare |  |
| Blue Cross NC - Dental Blue Select | Dental | NC | Commercial |  |
| Blue Cross of Idaho Federal Employees Program | Medical | ID | Commercial |  |
| Blue Medicare PPO/HMO of North Carolina | Medical, Dental | NC | Commercial, Medicare Advantage |  |
| Blue Ridge Independence at Home PACE | Medical | VA | Medicaid, Medicare |  |
| Blue Shield of California - Federal | Medical, Dental, Vision | CA | Commercial, Medicaid |  |
| Blue Shield of California HMO Encounters | Medical | CA | Commercial, Medicaid |  |
| Blue Shield of California Home Infusion Therapy | Medical | CA | Commercial, Medicaid, Medicare Advantage |  |
| Blue Shield of California Medicare Advantage Encounters | Medical | CA | Commercial |  |
| Blue Shield of California Promise Health Plan | Medical, Dental, Vision | CA | Medicaid |  |
| Blue Shield of California Promise Health Plan (Care1st Health Plan California) | Medical, Dental, Vision | CA | Medicaid, Medicare Advantage |  |
| Blue Shield of Pennsylvania | Dental | PA | Medicare Advantage |  |
| BlueChoice HealthPlan of South Carolina | Medical, Dental, Vision | SC | Commercial |  |
| BlueCross BlueShield of South Carolina Federal Employee Program | Medical, Dental, Vision | SC | Commercial |  |
| BlueCross BlueShield of South Carolina Medicare Blue | Medical, Dental, Vision | SC | Medicare Advantage |  |
| BlueCross BlueShield of South Carolina Planned Administrators, Inc. | Medical, Dental, Vision | SC | Commercial |  |
| BlueCross BlueShield of South Carolina State Health Plan | Medical, Dental, Vision | SC | Commercial |  |
| BlueCross BlueShield of Tennessee (Chattanooga HMO Plans) | Medical, Dental, Vision | TN | Commercial |  |
| BlueRide Non-Emergency Transportation | Medical | MN | Medicaid |  |
| Bluestem PACE | Medical, Dental | KS | Medicaid, Medicare |  |
| BMW North America | Medical |  | Workers' Compensation |  |
| Boilermakers National Funds | Medical, Dental |  | Commercial |  |
| Bollinger Incorporated | Medical | Nationwide |  |  |
| Boon-Chapman | Medical, Dental, Vision | Nationwide | Commercial |  |
| Boston University Dental Health Plan | Dental | MA | Commercial |  |
| Boulder Administration Services | Medical | CO | Commercial |  |
| BPA - Hylton Payroll  | Medical | Nationwide | Commercial |  |
| Brain & Spine Network Center of Excellence | Medical | TN | Commercial |  |
| BreckPoint | Medical, Dental |  | Commercial |  |
| BridgeSpan Health | Medical, Dental, Vision | ID, OR, UT, WA | Commercial |  |
| Bridgeview | Medical | MN | Medicaid |  |
| Britton Benefit Services | Medical |  | Commercial |  |
| BRMS | Medical, Dental | Nationwide | Commercial |  |
| Broadspire | Medical | Nationwide | Workers' Compensation |  |
| Broward PACE Program | Medical | FL | Medicaid, Medicare |  |
| Brown & Toland Health Services | Medical | CA | Commercial |  |
| Brown and Toland Medical Group | Medical |  | Commercial |  |
| Brownyard Group Incorporated (Arch Insurance) | Medical | Nationwide |  |  |
| Brunswick Corporation | Medical |  | Workers' Compensation |  |
| BSI Companies | Medical, Dental |  | Commercial |  |
| Buena Ventura Affiliated Physicians Inc | Medical |  |  |  |
| Bureau of Prisons | Medical | Nationwide |  |  |
| Business Administrators & Consultants | Medical, Dental |  | Commercial |  |
| Bywater | Medical |  | Commercial |  |
| C and O Employees’ Hospital Association | Medical |  | Medicare Advantage |  |
| California Eye Care New Century Health | Medical, Vision | CA | Commercial |  |
| California Fair Services Authority | Medical | CA | Workers' Compensation |  |
| California Home Health And Hospice (Medicare California Part A) | Medical, Dental | CA | Medicare |  |
| California Insurance Guarantee Association (CIGA) | Medical | CA | Workers' Compensation |  |
| Calvos SelectCare | Medical, Dental | GU | Commercial |  |
| Cameron Manufacturing and Design | Medical | Nationwide | Commercial |  |
| Camp LeJeune Family Member Program | Medical | Nationwide |  |  |
| Canon Cochran Management Services Incorporated | Medical |  | Commercial |  |
| Canopy Health | Medical | CA | Commercial |  |
| Capitol Administrators (Lucent Health) | Medical, Dental | CA | Commercial |  |
| CapRock Health Plans (90 Degree Benefits) | Medical, Dental | Nationwide | Commercial |  |
| Captrue Benefits | Medical, Dental, Vision | Nationwide | Commercial |  |
| Care N' Care | Medical | TX |  |  |
| Care to Care (Premier) | Medical |  | Commercial |  |
| Care1st Health Plan Arizona | Medical, Dental | AZ | Medicaid, Medicare Advantage |  |
| CareCentrix | Medical | Nationwide | Commercial |  |
| CareCentrix Blue Cross Blue Shield Michigan | Medical, Vision | Nationwide |  |  |
| CareCentrix Fallon and MGBH  | Medical, Dental, Vision | Nationwide | Commercial |  |
| CareCentrix Florida Blue | Medical, Dental, Vision | FL |  |  |
| CareCentrix Horizon | Medical, Dental, Vision | Nationwide |  |  |
| CareCentrix Wellcare | Medical, Dental, Vision | Nationwide | Medicare |  |
| CareCore National (Evicore) | Medical | Nationwide | Commercial |  |
| CareCore Oxford Radiology | Medical | Nationwide |  |  |
| CareFactor | Medical, Dental |  | Commercial |  |
| CareFactor | Medical |  | Commercial |  |
| CareFirst Blue Cross Blue Shield Maryland - Dental | Dental | DE, FL, MD, NC, PA, VA, WV, DC |  |  |
| CareFirst Community Health Plan Maryland | Medical, Dental, Vision | MD | Medicaid |  |
| Careington Benefit Solutions | Dental, Vision | Nationwide | Commercial |  |
| Carelon Aetna Home Health | Medical | Nationwide | Commercial |  |
| Carelon Anthem Home Health | Medical | Nationwide | Commercial |  |
| Carelon Behavioral Health CA - CYBHI Program | Medical | CA | Commercial, Medicaid |  |
| Carelon Health of Pennsylvania | Medical | PA | Medicaid |  |
| Caremore Health - Advanced Primary Care | Medical | AZ, CA, NV, TN |  |  |
| Carisk Partners | Medical |  | Commercial |  |
| Carolina SeniorCare | Medical, Dental | NC | Medicare |  |
| Carpenters Benefit Plan | Medical |  | Commercial |  |
| Cascade Health Alliance | Medical, Dental, Vision | OR | Medicaid |  |
| Caterpillar Inc. | Medical, Dental |  | Commercial |  |
| Catholic Health System PACE | Medical, Dental | NY | Medicaid, Medicare |  |
| Catilize Health | Medical |  | Commercial |  |
| CBA Blue | Medical, Dental, Vision | MA | Commercial |  |
| CCA Health Michigan | Medical | MI |  |  |
| CCA Health of California Fee-for-Service | Medical | CA |  |  |
| CCMSI | Medical |  | Workers' Compensation |  |
| CCMSI (Cannon Cochran Management Services, Inc.) | Medical |  | Commercial |  |
| Cedar Gate Technologies | Medical |  |  |  |
| Cedar Valley Community Healthcare | Medical | IA | Commercial |  |
| Cedars-Sinai Medical Network Services | Medical | CA | Commercial |  |
| Cedars-Sinai Medical Network Services Encounters | Medical | CA | Commercial |  |
| CEHAS Plan Administrators  | Medical | VA | Commercial |  |
| Celtic | Medical, Dental | DE | Commercial |  |
| Cement Masons Union Local 502 | Dental | IL | Commercial |  |
| CenCal Health | Medical | CA | Medicaid, Medicare Advantage |  |
| Centauri Health Solutions | Medical |  | Medicaid |  |
| Centene Dental and Vision Services | Medical, Dental, Vision | Nationwide | Medicaid |  |
| Center Care (Meritain) | Medical | KY | Commercial |  |
| Center Care Select | Medical |  |  |  |
| Center for Elders’ Independence | Medical, Dental | CA | Medicaid, Medicare |  |
| Center IPA | Medical | CA | Commercial |  |
| CenterLight Healthcare | Medical | NY | Medicaid, Medicare |  |
| Centers Plan for Healthy Living | Medical | NY | Medicaid, Medicare Advantage |  |
| Centinela Valley IPA | Medical |  |  |  |
| Centivo | Medical, Dental | NY | Commercial |  |
| Central California Physician Partners | Medical | CA | Commercial |  |
| Central Health Medicare Plan | Medical, Vision | CA | Medicare |  |
| Central Health Medicare Plan  | Medical | CA | Medicare |  |
| Central Pennsylvania Teamsters Health & Welfare Fund | Medical, Dental | PA | Commercial |  |
| Central Valley Medical Providers (CVMEDPRO) | Medical | CA | Medicare Advantage |  |
| Centrix Benefit Administrators | Medical, Dental |  | Commercial |  |
| Centurion Health | Medical, Dental | FL, GA, ID, IL, IN, KS, MD, MN, MO, TN |  |  |
| Chaffey Medical Group | Medical | CA | Commercial |  |
| Champion Payer Solutions | Medical | CA, NV | Commercial |  |
| CHAMPVA HAC | Medical, Dental, Vision | Nationwide | Veterans Affairs |  |
| Charles Taylor | Medical | Nationwide | Workers' Compensation |  |
| Cherokee Nation Comprehensive Care Agency | Medical | OK | Medicaid, Medicare |  |
| Chesterfield Resources | Medical, Dental |  | Commercial |  |
| Chicago Health Systems | Medical | IL | Commercial |  |
| Children First Medical Group | Medical | CA | Commercial |  |
| Chinese Community Health Plan | Medical | CA | Medicaid, Medicare Advantage |  |
| CHOC Children's Hospital Orange County Health Alliance | Medical | CA |  |  |
| Choice Medical Group | Medical | CA | Commercial |  |
| Choice Physician Network | Medical | CA | Commercial |  |
| Choice Physicians Network - RINCO | Medical | CA | Commercial |  |
| Choice Physicians Network (Nivano Physicians) | Medical | CA | Commercial, Medicare Advantage |  |
| Choice Physicians Network Advent Health Medical Corporation | Medical | CA | Commercial |  |
| Choice Physicians Network First Choice | Medical | CA | Commercial |  |
| Choiceone Independent Practice Association | Medical | CA | Commercial |  |
| Christian Brothers Services | Medical, Dental, Vision | Nationwide | Commercial |  |
| Christian Care Ministry | Medical, Dental, Vision | Nationwide |  |  |
| Christian Health Aid | Medical |  | Commercial |  |
| Christiana Care Value-Based Reimbursement | Medical | DE, PA | Commercial |  |
| Christus Health Medicare Advantage | Medical, Vision | NM, TX | Medicare Advantage |  |
| Christus Health Plan LA Exchange | Medical, Dental | LA, TX | Commercial |  |
| Christus Health Plan Nueces County Hospital District | Medical | TX | Medicaid |  |
| Christus Health US Family Health Plan | Medical, Dental, Vision | Nationwide | TRICARE |  |
| Cities and Villages Mutual Insurance Company | Medical, Dental | WI | Workers' Compensation |  |
| City of Pompano Beach (Florida) | Medical | FL | Workers' Compensation |  |
| City of Topeka (Kansas) | Medical | KS | Workers' Compensation |  |
| City of West Covina (California) | Medical | CA | Workers' Compensation |  |
| City of West Palm Beach (Florida) | Medical | FL | Workers' Compensation |  |
| Clackamas County Mental Health | Medical | OR |  |  |
| ClaimChoice | Medical |  | Commercial |  |
| ClaimChoice Administrators | Medical |  | Commercial |  |
| Claims Development Corporation | Medical |  | Commercial |  |
| Clearwater Benefits | Medical | Nationwide | Commercial |  |
| Clever Care Health Plan | Medical | CA | Medicare Advantage |  |
| Clifton Health Systems DBA Actin Care Groups | Medical | IL | Commercial |  |
| Clover Health | Medical, Dental, Vision | GA, MS, NJ, PA, SC, TX | Medicare |  |
| Clover Health | Medical, Dental, Vision | AZ, GA, MS, NJ, PA, SC, TN, TX | Medicare Advantage |  |
| CNA Insurance | Medical | Nationwide | Commercial |  |
| CNA Insurance (Auto Only) | Medical | Nationwide | Commercial |  |
| Co-ordinated Benefits Plans | Medical, Dental |  |  |  |
| Coachella Medical Group | Medical | CA | Commercial |  |
| Coastal Administrative Services | Medical, Dental | Nationwide | Commercial |  |
| Coastal Community Physician Network (CCPN) (Regal) | Medical |  |  |  |
| Coastal TPA | Medical |  | Commercial |  |
| Coeur Plan Services | Medical | TX | Commercial |  |
| Collective Health | Medical | Nationwide | Commercial |  |
| Collective Health Administrators | Medical, Dental, Vision | Nationwide | Commercial |  |
| Colorado Access | Medical, Dental | CO | Medicaid |  |
| Columbine Health Plan | Medical | CO | Commercial |  |
| Commonwealth Care Alliance (CCA) | Medical, Dental | CA, MA, RI | Medicaid, Medicare Advantage |  |
| CommuniCare Advantage | Medical | IN, MD, OH | Medicare Advantage |  |
| Community Behavioral Health | Medical | PA | Medicaid |  |
| Community Care Alliance of Illinois | Medical | CO, IL, VA | Medicaid, Medicare Advantage |  |
| Community Care Behavioral Health Organization | Medical, Dental | PA | Medicaid |  |
| Community Care Collaborative | Medical | TX |  |  |
| Community Care Family Care | Medical | WI | Medicaid |  |
| Community Care Family Care Partnership or PACE | Medical | WI | Medicaid, Medicare |  |
| Community Care Independent Practice Association | Medical |  |  |  |
| Community Care Plan | Medical | FL | Commercial, Medicaid |  |
| Community Care Plan (Broward Health PPUC) | Medical | FL | Medicaid |  |
| Community Care Plan (Florida Healthy Kids) | Medical | FL | Medicaid |  |
| Community Care Plan (Managed Medical Assistance) | Medical | FL | Medicaid |  |
| Community Eye Care | Medical, Vision |  | Commercial |  |
| Community Family Care | Medical | CA | Commercial |  |
| Community Health Alliance | Medical | IN, MI | Commercial |  |
| Community Health Center Network | Medical | CA | Medicaid |  |
| Community Health Choice | Medical, Dental | TX | Medicaid, Medicare |  |
| Community Health Choice | Medical, Dental | TX | Commercial |  |
| Community Health Group | Medical, Dental | CA | Medicaid |  |
| Community Health Options | Medical, Dental | ME | Commercial |  |
| Community Health Plan of Washington | Medical, Dental, Vision | WA | Commercial, Medicaid, Medicare Advantage |  |
| Community LIFE | Medical | PA | Medicaid, Medicare |  |
| CommunityCare | Medical, Dental | OK | Commercial, Medicare Advantage |  |
| CommunityCare IPA | Medical | CA | Commercial |  |
| Companion Life | Dental | Nationwide | Commercial |  |
| Companion Life Insurance Company of California (LOB CLIC) | Medical | Nationwide | Commercial |  |
| Compass Health Administrators | Medical |  | Commercial |  |
| CompBenefits Dental | Dental | IL | Commercial |  |
| Complementary Health Care | Medical |  | Commercial, Medicaid |  |
| Complete Senior Care, PACE | Medical, Dental | NY | Medicaid, Medicare |  |
| ComPsych | Medical | Nationwide | Commercial |  |
| Concentrix Insurance Solutions | Medical |  |  |  |
| Conifer Health Solutions | Medical, Dental |  | Commercial |  |
| Conifer Health Solutions | Medical |  | Commercial |  |
| Conifer Health Solutions | Medical |  | Commercial |  |
| Connecticut Behavioral Health Partnership | Medical | CT | Medicaid |  |
| ConnectiveRx | Medical |  | Commercial |  |
| Consociate Health | Medical |  | Commercial |  |
| Consociate Health for Cancer and Transplant | Medical |  | Commercial |  |
| Consolidated Tribal Health Project | Medical | CA |  |  |
| Container Graphics Corporation | Medical | Nationwide | Commercial |  |
| Contessa Health | Medical |  |  |  |
| Contessa Health Security Health Plan | Medical |  |  |  |
| Continental General | Medical | TX | Commercial |  |
| Contra Costa Behavioral Health Plan | Medical | CA | Medicaid |  |
| Contra Costa Health Plan | Medical | CA | Commercial, Medicaid |  |
| Cook Group Health Plan | Medical | IN | Commercial |  |
| Coralisle Group | Medical | Nationwide | Commercial |  |
| Coralisle Group | Medical |  |  |  |
| Coralisle Group | Medical |  |  |  |
| Coralisle Group | Medical |  |  |  |
| Core Management Resources GP | Medical, Dental |  | Commercial |  |
| CoreCivic | Medical |  | Workers' Compensation |  |
| CoreCivic | Medical |  |  |  |
| Cornerstone Hospice and Palliative Care, Inc. | Medical | FL, GA |  |  |
| Cornerstone Preferred Resources | Medical | TX | Commercial |  |
| Corporate Benefit Services (90 Degree Benefits) | Medical, Dental, Vision | NC | Commercial |  |
| CorrectCare (Georgia Correctional Healthcare Adult Health) | Medical | GA |  |  |
| CorrectCare (Louisiana Prisons and Parish Jails) | Medical | LA |  |  |
| CorrectCare Integrated Health | Medical | CA |  |  |
| CorrectCare Integrated Health (Non-Louisiana Jails) | Medical | Nationwide | Medicaid |  |
| Correctional Health Partners | Medical | CA, CO, OR |  |  |
| CorVel Single Payor ID – Workers Compensation | Medical | Nationwide | Automobile medical, Workers' Compensation |  |
| Country Life Insurance Company | Medical, Vision | IL | Commercial |  |
| County of Fresno | Medical | CA |  |  |
| County of Sacramento - Emergency Medical Services Fund | Medical | CA |  |  |
| Covet Health | Medical |  | Commercial |  |
| Cow Creek Band of Umpqua Tribe of Indians (CCBUTI) | Medical, Dental | OR |  |  |
| Coworx Staffing LLC | Medical |  | Workers' Compensation |  |
| Cox HealthPlans | Medical | MO | Commercial |  |
| CoxHealth Network | Medical, Dental |  | Commercial |  |
| Create Health Plans | Medical | Nationwide | Commercial |  |
| Creative Plan Administrators | Medical |  | Commercial |  |
| Crossway HealthShare | Medical |  |  |  |
| Crown City Medical Group (CCMG) | Medical |  |  |  |
| Crumdale Claims Solutions | Medical |  | Commercial |  |
| CSEA Employee Benefit Fund | Dental | NY |  |  |
| CSI Life Insurance Company | Medical, Vision | AZ, CO, GA, IL, MS, NC, SC, TN, TX | Medicare |  |
| Culinary Health Fund | Medical | NV | Commercial |  |
| Culinary Health Fund | Medical, Dental | NV | Commercial |  |
| Curaechoice | Medical |  |  |  |
| Curative | Medical, Dental | FL, GA, TX | Commercial |  |
| Custom Design Benefits | Medical | OH, IN, KY |  |  |
| CVS Caremark Minute Clinic | Medical |  | Workers' Compensation |  |
| CWIBenefits | Medical |  | Commercial |  |
| Cypress Benefit (Lucent Health) | Medical, Dental |  | Commercial |  |
| Cypress Dental | Dental |  | Commercial |  |
| Daniel H. Cook Associates | Medical | IN |  |  |
| Dearborn Group | Vision |  | Commercial |  |
| DeCare Dental | Dental |  | Commercial |  |
| DeCare Dental | Dental |  | Commercial |  |
| Dell Children's Health Plan | Medical, Dental | TX | Medicaid |  |
| Delta Health Systems | Medical, Dental |  |  |  |
| Delta Health Systems | Medical |  | Commercial |  |
| Delta Health Systems | Medical, Dental | UT | Commercial |  |
| DeltaCare USA (Claims) | Dental |  | Medicare Advantage |  |
| DeltaCare USA (Encounters) | Dental |  | Medicare Advantage |  |
| Dentist Direct | Dental |  | Commercial |  |
| Denver Health Medical Plan | Medical | CO | Commercial, Medicaid, Medicare Advantage |  |
| Denver Health Medical Plan | Medical | CO | Commercial, Medicaid, Medicare Advantage |  |
| Department of Labor Black Lung | Medical | Nationwide |  |  |
| Deseret Mutual Benefit Administrators (DMBA) | Medical, Dental | UT | Commercial |  |
| Detego Health | Medical, Dental |  | Commercial |  |
| DGA-Producer Pension and Health Plans | Medical, Dental, Vision | CA | Commercial |  |
| Dignity Global | Medical | CA | Commercial |  |
| Dignity Health Management Services | Medical, Dental, Vision | CA | Commercial |  |
| Dignity Health Management Services Organization | Medical | CA | Commercial |  |
| Dignity Medical Foundation Professional Capitated NonPayment | Medical | CA | Commercial |  |
| Doctors HealthCare Plans | Medical | FL | Medicare Advantage |  |
| Dominion National | Dental |  | Commercial |  |
| DPSC Inc. | Medical | FL |  |  |
| Dunn Benefits | Medical, Dental |  | Commercial |  |
| Dunn-Edwards Corporation | Medical | CA | Workers' Compensation |  |
| Early Intervention Central Billing | Medical | IL |  |  |
| East West Administrators | Medical |  | Commercial |  |
| Easterseals Southern California | Medical |  |  |  |
| EBA&M | Medical |  | Commercial |  |
| Ebix Health Administration Exchange (EHAE) | Medical |  |  |  |
| EBMS | Dental |  | Commercial |  |
| EBS | Medical |  | Commercial |  |
| EDDY Seniorcare | Medical, Dental | NY | Medicaid, Medicare |  |
| Edenbridge Health | Medical, Dental | MD | Medicaid, Medicare |  |
| Edenbridge of DC | Medical, Dental | DC | Medicaid, Medicare Advantage |  |
| Edison Health Solutions | Medical |  | Commercial |  |
| Edison Health Solutions (EHS) | Medical |  | Commercial |  |
| Edison Revolution | Medical |  |  |  |
| El Camino Health Alliance | Medical |  |  |  |
| El Camino Health Medical Network | Medical |  |  |  |
| El Paso Community College (Texas Jurisdiction) | Medical | TX | Workers' Compensation |  |
| El Paso First Health Plan HCO Healthcare Options | Medical | TX | Commercial, Medicaid, Medicare Advantage |  |
| El Paso First Health Plans CHIP | Medical | TX | Medicaid |  |
| El Paso First Health Plans Premier Plan STAR Medicaid HMO  | Medical | TX | Medicaid |  |
| El Paso Health Advantage Dual SNP | Medical | TX | Medicaid, Medicare Advantage |  |
| El Proyecto del Barrio | Medical | CA | Commercial |  |
| Elderhaus | Medical, Dental | NC | Medicaid, Medicare |  |
| Elderplan | Medical, Dental | NY | Medicaid, Medicare Advantage |  |
| ElderServe Health | Medical | NY | Medicaid, Medicare |  |
| Electric Welfare Trust Fund | Medical, Dental |  | Commercial |  |
| Electrical Workers Insurance Fund Local 58 | Medical | MI |  |  |
| Element Care Incorporated | Medical | MA | Medicaid, Medicare |  |
| Elevate Patient Financial Solutions | Medical | Nationwide |  |  |
| Elevate Provider Network | Pharmacy |  |  |  |
| ElevatePFS | Medical |  |  |  |
| Elips Life Insurance Company | Medical, Vision | DC, NY | Medicare |  |
| Elite Health Plan | Medical | CA | Medicare Advantage |  |
| Emanate Health Independent Practice Association | Medical | CA | Commercial |  |
| Emanate Health IPA - Astrana | Medical | CA | Commercial |  |
| EMC Insurance | Medical | Nationwide |  |  |
| EMC Insurance | Medical | Nationwide | Automobile medical |  |
| EMC Risk Services | Medical | Nationwide |  |  |
| EMCASCO Insurance Company Workers' Compensation Only | Medical | Nationwide | Workers' Compensation |  |
| Emerging Therapy Solutions | Medical |  | Commercial |  |
| EMI - KP Ambulance Claims | Medical | UT, AZ |  |  |
| Employee Benefit Management Services | Medical, Dental, Vision |  |  |  |
| Employee Benefit Services | Medical, Dental |  |  |  |
| Employee Benefit Services (South Carolina) | Medical, Dental | SC | Commercial, Medicare Advantage |  |
| Employee Benefits Services Organisation (90 Degree Benefits) | Medical | Nationwide | Commercial |  |
| Employee Plans LLC | Medical | Nationwide | Commercial |  |
| Employer Coalition on Health - ECOH | Medical | IL | Commercial |  |
| Employer Driven Insurance Services | Medical | AZ, CA, CO, KS, MI, NV, OR, SC, TX, UT, DC | Commercial |  |
| Employer Insurance Group (EIG) | Medical |  | Workers' Compensation |  |
| Employer Plan Services Incorporated (EPSI) | Medical | TX | Commercial |  |
| Employers Coalition on Health (ECOH) | Medical, Dental |  | Commercial |  |
| Employers Direct Health Employee Plan | Medical | TX | Commercial |  |
| Employers Health Network | Medical | AZ, AR, CA, CO, FL, IL, NC, OK, SC, TN, TX, WA | Commercial, Medicaid |  |
| EnableComp Commercial | Medical |  | Commercial |  |
| EnableComp Motor Vehicle Accident | Medical |  | Automobile medical |  |
| EnableComp OOS Medicaid | Medical | Nationwide | Medicaid |  |
| EnableComp Veterans Administration | Medical |  |  |  |
| EnableComp Workers Compensation | Medical |  | Workers' Compensation |  |
| EnableCompMVA | Medical | Nationwide |  |  |
| EnableCompVET | Medical | Nationwide |  |  |
| Encara | Dental | VA, WA, WI |  |  |
| Endeavor Health | Medical | IL | Commercial |  |
| Enterprise Group Planning | Medical |  |  |  |
| Entrust (90 Degree Benefits) | Medical, Dental, Vision | Nationwide | Commercial |  |
| Envolve Vision of Puerto Rico | Medical, Vision | PR | Medicaid |  |
| EOB TPA  | Medical |  |  |  |
| Equitable | Dental |  |  |  |
| Erisa Administrative Services | Medical, Dental, Vision | NM | Commercial |  |
| ES Beveridge and Associates | Medical, Dental |  |  |  |
| ESIS | Medical | Nationwide |  |  |
| ESIS – Workers Compensation | Medical |  | Workers' Compensation |  |
| ESIS (First American Insurance Company) | Medical |  | Workers' Compensation |  |
| ESIS Kelly Services | Medical |  | Workers' Compensation |  |
| ESIS Lockheed Martin Corporation | Medical |  | Workers' Compensation |  |
| Esperanza IPA | Medical | CA | Commercial |  |
| Essential Health Partners | Medical | IL | Commercial |  |
| Essential Health Partners Independent Practice Association (IPA) | Medical | IL | Medicare |  |
| Eternal Health | Medical | MA | Medicare Advantage |  |
| Everence Financial | Medical, Dental, Vision |  | Commercial |  |
| Everest Reinsurance Company | Medical, Vision |  | Medicare |  |
| Evernorth | Medical, Dental, Vision |  | Commercial |  |
| EverPointe | Medical | WI |  |  |
| EviCore by Evernorth | Medical |  |  |  |
| Evolent Specialty - Cardiology | Medical, Vision |  |  |  |
| Evolent Specialty - Oncology | Medical |  |  |  |
| Evolent Specialty - Radiation Oncology | Medical |  |  |  |
| Evolent Specialty - Urology | Medical |  |  |  |
| Evolent Specialty Institutional | Medical |  |  |  |
| Evolutions Healthcare Systems | Medical, Dental | FL | Commercial |  |
| Evry Health | Medical | TX | Commercial |  |
| Exclusive Care - County of Riverside | Medical | CA | Commercial |  |
| Exemplar | Medical |  | Commercial |  |
| Exemplar Health Insurance Company (Medicare) | Medical |  | Medicare |  |
| EyeMed | Medical, Vision |  | Commercial |  |
| Facey Medical Foundation | Medical | CA | Commercial |  |
| FairPrice | Medical |  | Commercial |  |
| Fairview Health Services | Medical | MN | Workers' Compensation |  |
| Falling Colors | Medical | NM | Medicaid |  |
| Family Care Specialists | Medical | CA | Commercial |  |
| Family Choice Medical Services | Medical | CA | Commercial |  |
| Family HealthCare Program of All-Inclusive Care for the Elderly | Medical, Dental | CA | Medicaid, Medicare |  |
| Farmers Insurance | Medical |  | Workers' Compensation |  |
| Farmers Insurance (Auto Only) | Medical |  | Automobile medical |  |
| FCE Benefit Administrators | Medical | CA | Commercial |  |
| FCL Dental | Dental | Nationwide | Commercial |  |
| Federated Rural Electric (Texas) | Medical | TX |  |  |
| Federated Services Insurance Company | Medical |  |  |  |
| Fenyx Health | Medical | Nationwide | Medicare Advantage |  |
| FHC of Puerto Rico | Medical | PR | Medicare Advantage |  |
| Fidelity Security Life Insurance Company | Medical |  |  |  |
| Fire Department City of New York World Trade Center Health Plan | Medical | Nationwide |  |  |
| Firefly Health | Medical | MA | Commercial |  |
| First Agency | Medical |  | Commercial |  |
| First Ameritas New York | Dental | NY | Commercial |  |
| First Choice Health Plan of Mississippi | Medical | MS | Commercial |  |
| First Health Network | Medical, Dental |  | Commercial |  |
| First Medical Health Plan | Medical | PR | Commercial, Medicaid, Medicare Advantage |  |
| First Medical Puerto Rico Government Health Plan (VITAL) | Medical, Dental | PR | Medicaid |  |
| FirstCare | Medical, Dental | TX | Medicaid |  |
| FirstCare Health Plans | Medical, Dental | TX | Commercial, Medicaid, Medicare |  |
| FirstCarolinaCare | Medical | NC | Commercial, Medicare |  |
| Florida Blue Medicare | Medical, Dental, Vision | FL | Commercial, Medicare Advantage |  |
| Florida Community Care | Medical | FL | Medicaid |  |
| Florida Complete Care | Medical | FL | Medicaid, Medicare Advantage |  |
| Florida Fruit and Vegetable Association | Medical | FL | Workers' Compensation |  |
| Florida Health Administrators | Medical | Nationwide |  |  |
| Florida Health Care Plans | Medical, Dental | FL | Commercial, Medicare Advantage |  |
| Florida PACE Centers | Medical | FL | Medicaid, Medicare |  |
| Flume Health Inc. | Medical |  | Commercial |  |
| Foremost | Medical | Nationwide |  |  |
| Forest County Potawatomi Insurance Department | Medical, Dental | WI |  |  |
| Foundation for Medical Care of Tulare and Kings Counties | Medical | CA | Commercial |  |
| Fox Everett | Medical |  | Commercial |  |
| Franciscan Senior Health and Wellness PACE | Medical, Dental | IN | Medicare |  |
| Free Market Administrators | Medical |  | Commercial |  |
| Freedom Claims Management | Medical, Dental | KS | Commercial |  |
| Freedom Health | Medical | FL | Medicare Advantage |  |
| Freedom Life Insurance of America | Medical, Dental, Vision |  | Commercial, Medicare |  |
| Fringe Benefit Coordinators | Medical, Dental | Nationwide | Commercial |  |
| Fringe Benefit Group | Medical, Dental |  | Commercial |  |
| Fringe Benefit Group | Medical, Dental | TX | Commercial |  |
| Frontier Direct Care | Medical | TX | Commercial |  |
| FrontPath Health Coalition | Medical | OH, MI, IN |  |  |
| Fulcrum | Medical |  |  |  |
| FutureComp | Medical, Dental | CT, ME, MA, NH, NJ, NY, PA, RI, VT | Workers' Compensation |  |
| Gab Robbins Incorporated | Medical |  |  |  |
| Gallagher Bassett | Medical |  | Workers' Compensation |  |
| Gallagher Bassett – Workers Compensation | Medical |  | Workers' Compensation |  |
| Garden State Life Insurance Company | Medical, Vision | NY, TX | Medicare |  |
| Genesee County Health Plan (MB) - JVHL | Medical | MI | Commercial, Medicaid |  |
| Genesys-Oconee Detention Center SC | Medical | SC |  |  |
| Genex Care for Ohio | Medical | OH | Workers' Compensation |  |
| Georgia Health Advantage | Medical, Vision | GA | Medicare Advantage |  |
| GHA Orthopedic Providers (Cedar Gate Technologies) | Medical |  |  |  |
| Global Care Medical Group IPA | Medical, Dental | CA |  |  |
| Global Excel | Medical |  | Commercial |  |
| Global Excel | Medical |  |  |  |
| Global Medical Management International Customer Care | Medical |  |  |  |
| Global One Ventures | Medical |  | Commercial |  |
| Global TBSP | Medical |  | Commercial |  |
| Global Women's Health (Cedar Gate Technologies) | Medical |  |  |  |
| GlobalHealth Texas | Medical | TX | Medicare Advantage |  |
| Globe Life | Medical |  | Commercial, Medicare |  |
| Globe Life Insurance Company of New York | Medical | NY | Medicare |  |
| GMS | Medical | OH | Commercial |  |
| Gold Coast Health Plan | Medical | CA | Medicaid |  |
| Golden Coast MSO | Medical | CA | Commercial |  |
| Golden State Medical Group | Medical | CA | Commercial |  |
| Gonzaba Medical Group | Medical | TX | Commercial |  |
| Grange Insurance | Medical | AZ, CO, GA, IL, IA, KS, MN, MO, NE, NV, ND, OH, OR, SD, UT, WA, WI | Workers' Compensation |  |
| Grange Mutual Casualty Company | Medical | MO |  |  |
| Grange Workers' Compensation | Medical |  | Workers' Compensation |  |
| Graphic Arts Mutual | Medical | NY |  |  |
| Gravie | Medical, Dental | MN | Commercial |  |
| Great American Alliance Insurance Company | Medical | Nationwide |  |  |
| Great American Insurance Company of New York | Medical | Nationwide |  |  |
| Great Divide Insurance | Medical | ND |  |  |
| Greater Covina Medical Group | Medical | CA | Commercial |  |
| Group Administrators Ltd | Medical |  | Commercial |  |
| Group and Pension Administrators | Medical, Dental |  | Commercial |  |
| Group Benefit Services | Medical, Dental |  |  |  |
| Group Health Cooperative of Eau Claire | Medical, Dental | WI | Commercial |  |
| Group Health Cooperative of South Central Wisconsin | Medical, Dental | WI | Commercial, Medicare |  |
| Group Health Northwest | Medical | WA |  |  |
| Group Management Services | Medical |  | Commercial |  |
| Group Marketing Services | Medical, Dental | MI | Commercial |  |
| Guarantee Trust Life | Medical |  | Medicare |  |
| Guidehealth | Medical |  | Commercial |  |
| Guidehealth Behavioral Health Network | Medical |  |  |  |
| Gulf Guaranty Health | Medical | MS |  |  |
| Gulf South Risk Services (Valenz) | Medical, Dental |  | Commercial |  |
| GWH Cigna (Great West Healthcare) | Medical, Dental, Vision |  |  |  |
| GWH-Cigna | Medical, Dental, Vision |  |  |  |
| Halcyon Behavioral Health | Medical |  | Commercial |  |
| Halos Systems | Medical |  |  |  |
| Hamaspik | Medical | NY | Medicare Advantage |  |
| Hanover Insurance Company | Medical |  | Workers' Compensation |  |
| HAP CareSource MI Health Link | Medical, Dental | MI | Medicaid, Medicare |  |
| Harbor Health | Medical | TX | Commercial |  |
| Hartford Fire Insurance Company | Medical |  |  |  |
| Hartford Insurance Company of the Midwest | Medical |  |  |  |
| Hartford Life and Accident Insurance Company | Medical |  |  |  |
| Hartford Life and Annuity Insurance Company | Medical |  |  |  |
| Hawaii Dental Service | Dental | HI | Commercial, Medicaid |  |
| Hawaii-Mainland Administrators | Medical, Dental | HI | Commercial |  |
| Hawaii-Western Management Group | Medical, Dental | HI | Commercial |  |
| HCA | Medical |  | Workers' Compensation |  |
| HCC Life Insurance | Medical |  |  |  |
| Health 2 Business | Medical | ID, KY, MO, OH, OR | Commercial |  |
| Health Alliance (Illinois) | Medical, Vision | IL, IN, IA | Medicare |  |
| Health and Human Services National Disaster Medical System | Medical | Nationwide |  |  |
| Health Care District of Palm Beach County | Medical | FL |  |  |
| Health Care Los Angeles Independent Practice Association (HCLA) | Medical | CA | Commercial |  |
| Health Choice BCBS of Arizona ACA | Medical, Dental | AZ | Commercial |  |
| Health Choice Utah | Medical | UT | Medicaid |  |
| Health In Tech | Medical | Nationwide |  |  |
| Health Network One | Medical |  |  |  |
| Health Network Solutions (HNS) - Blue Cross Blue Shield of North Carolina | Medical | NC | Commercial, Medicaid, Medicare Advantage |  |
| Health Network Solutions (HNS) - MedCost NC | Medical |  | Commercial |  |
| Health New England | Medical, Dental | CT, MA | Commercial, Medicare Advantage |  |
| Health Partners Plans | Medical, Dental | PA | Commercial, Medicaid, Medicare |  |
| Health Partners Plans | Medical, Dental | PA | Medicaid |  |
| Health Payment Systems Incorporated | Medical | WI | Commercial |  |
| Health Plan of San Mateo | Medical, Dental | CA | Medicaid, Medicare Advantage |  |
| Health Plan of Upper Ohio Valley | Medical, Dental, Vision | WV | Commercial, Medicaid, Medicare Advantage |  |
| Health Plans Incorporated | Medical, Dental, Vision | Nationwide | Commercial |  |
| Health Services for Children with Special Needs | Medical | DC | Medicaid |  |
| Health Share of Oregon | Medical, Dental | OR | Medicaid |  |
| HealthBridge | Medical |  | Commercial |  |
| Healthcare Highways Health Plan | Medical |  | Commercial |  |
| Healthcare Management Administrators (HMA) | Medical, Dental, Vision | WA | Commercial |  |
| HealthCare Solutions Group (90 Degree Benefits) | Medical, Dental | Nationwide | Commercial |  |
| Healthchoice of Connecticut | Medical, Dental | CT |  |  |
| HealthEdge Administrators | Medical, Dental | CA | Commercial |  |
| HealthEquity | Medical | Nationwide |  |  |
| HealthEZ | Medical |  | Commercial |  |
| Healthfirst (Health Insurance for New Yorkers) | Medical, Dental | NY | Commercial, Medicaid, Medicare Advantage |  |
| HealthFirst TPA | Medical, Dental, Vision |  | Commercial, Medicaid |  |
| HealthFirst TPA (Austin) | Medical |  | Commercial |  |
| Healthgram | Medical, Dental, Vision |  |  |  |
| HealthLink | Medical | IL, MO | Commercial |  |
| Healthly Medical Group | Medical | CA |  |  |
| HealthPartners | Medical, Dental, Vision | MN, WI | Commercial, Medicare |  |
| HealthPartners | Medical | IL, IA, MD, MN, MO, NJ, ND, SD, WI, DC | Commercial, Medicaid, Medicare, Medicare Advantage |  |
| HealthPlan Services | Medical |  | Commercial |  |
| HealthSCOPE Benefits | Medical, Dental, Vision |  |  |  |
| HealthSmart | Medical, Dental |  | Commercial |  |
| HealthSmart | Medical |  | Commercial |  |
| HealthSmart | Medical |  | Commercial |  |
| HealthSmart | Medical |  | Commercial |  |
| HealthSmart Accel | Medical |  |  |  |
| HealthSmart MSO | Medical | CA |  |  |
| HealthSmart Oklahoma City | Medical | OK |  |  |
| HealthSmart Preferred Care Inc. | Medical | Nationwide |  |  |
| HealthSource MSO | Medical |  | Commercial |  |
| HealthSpring | Medical, Dental, Vision | AL, DE, FL, IL, MD, MN, NJ, PA, TN, TX, WA | Medicare Advantage |  |
| HealthTeam Advantage HMO C-SNP, Diabetes & Heart Care Plan | Medical | NC | Commercial, Medicaid, Medicare Advantage |  |
| Healthy Blue Dual Advantage of Louisiana | Medical, Dental, Vision | LA | Medicaid, Medicare Advantage |  |
| Healthy Community Network | Medical | PA |  |  |
| Helmsman Management Services | Medical |  | Commercial |  |
| Helmsman Management Services – Workers Compensation | Medical |  | Workers' Compensation |  |
| Hennepin Health | Medical, Vision | MN | Medicaid, Medicare Advantage |  |
| Heraya Health | Medical | OR, WA, ID, UT, MT, AK, CO | Commercial |  |
| Heraya Health | Medical | OR, WA, ID, UT, MT, AK, CO | Commercial |  |
| Heritage - Bureau Of Prisons (BOP) | Medical, Dental |  |  |  |
| Heritage Sierra Medical Group | Medical | CA | Commercial |  |
| Heritage Victor Valley Medical Group | Medical | CA | Commercial |  |
| Hero Health Plans | Medical |  | Commercial |  |
| High Desert PACE | Medical, Dental | CA | Medicaid, Medicare |  |
| Highmark Blue Shield of Northeastern New York | Medical, Dental, Vision | NY | Commercial, Medicare Advantage |  |
| Highmark Delaware Health Options | Medical, Dental | DE | Medicaid |  |
| Highmark Health Options Dual Plan | Medical | DE, WV | Medicaid, Medicare Advantage |  |
| Highmark Health Options Duals West Virginia | Medical | PA | Medicaid, Medicare Advantage |  |
| Highmark Health Options West Virginia | Medical, Dental | WV | Medicaid, Medicare Advantage |  |
| Highmark Wholecare | Dental | PA | Medicaid |  |
| Highmark Wholecare | Medical | PA | Medicaid |  |
| Hill Physicians Aetna Preferred Provider Organization | Medical | CA | Commercial |  |
| Hill Physicians Blue Cross PPO | Medical | CA | Commercial |  |
| Hill Physicians Blue Shield PPO | Medical | CA | Commercial |  |
| Hill Physicians Health Network Preferred Provider Organization | Medical | CA | Commercial |  |
| Hill Physicians Medical Group | Medical | CA | Commercial |  |
| Hill Physicians Medical Group Cigna PPO | Medical | CA | Commercial |  |
| Hill Physicians UnitedHealthcare PPO | Medical | CA | Commercial |  |
| Hillsborough County | Medical, Dental | FL | Commercial |  |
| Hinge Health | Medical |  |  |  |
| HIPnation | Medical | TN |  |  |
| Hispanic Physicians IPA | Medical | CA | Commercial, Medicaid, Medicare |  |
| HMSA | Medical, Dental, Vision | CA, HI, NV | Commercial, Medicaid, Medicare Advantage |  |
| HMSA Akamai Advantage | Medical | HI | Commercial, Medicare Advantage |  |
| Hoag Clinic (Hoag Physician Partners) | Medical | CA | Commercial |  |
| Holista | Medical |  | Commercial |  |
| Homeland Security (Deportation) | Medical, Dental | Nationwide |  |  |
| Homelink | Medical | Nationwide |  |  |
| Homelink HealthPartners | Medical |  |  |  |
| Homestead (INDECS) | Medical, Dental | DC, GA, LA, NJ, PA | Commercial |  |
| Hometown Health Plan MA HMO | Medical, Dental | NV |  |  |
| Hometown Health Providers | Medical | NV | Commercial |  |
| Homewood Resorts (UCS) | Medical | CA | Commercial |  |
| Horizon New Jersey Health | Medical, Dental | NJ | Medicaid, Medicare Advantage |  |
| Hortica Florist Mutual Insurance | Medical | AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, DC | Commercial |  |
| Hospital Sisters Health System Medical Group Independent Practice Association | Medical |  | Commercial |  |
| Housing Authority El Paso (Texas) | Medical | TX | Workers' Compensation |  |
| HPC | Medical |  |  |  |
| HPI Vanderbilt | Medical |  | Commercial |  |
| Humana Encounters | Medical, Dental | Nationwide | Commercial |  |
| Humana Long-Term Care | Medical, Dental | Nationwide | Commercial |  |
| Humboldt IPA | Medical | CA | Commercial |  |
| Humboldt Park Health Partners | Medical | IL |  |  |
| Huron PACE | Medical | MI | Medicaid, Medicare |  |
| I.E. Shaffer & Co. | Medical, Dental |  | Commercial |  |
| IBA | Medical, Dental | FL | Commercial |  |
| IBEW Local No. 1 Health and Welfare Fund | Medical, Dental | MO | Commercial |  |
| iCare Health Options TPA | Medical, Vision |  | Commercial, Medicaid |  |
| ICW Group | Medical |  | Workers' Compensation |  |
| IH Plans, Inc. | Medical, Dental |  | Commercial |  |
| Illinois Health Partners | Medical | IL | Commercial |  |
| illumifin | Medical | Nationwide | Medicare |  |
| ILWU - PMA Benefit Plans  | Medical |  | Commercial |  |
| Imagine360 | Medical, Dental, Vision | Nationwide | Commercial |  |
| IMCare | Medical, Dental | MN | Medicaid |  |
| Impact Health Sharing | Medical | AL, AK, AZ, AR, CA, CO, CT, DE, FL, GA, HI, ID, IL, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PA, SC, SD, TN, TX, UT, VT, VA, WV, WI, WY | Commercial |  |
| Imperial Health Holdings Medical Group | Medical | CA | Commercial |  |
| Imperial Health Plan of California | Medical | CA | Medicare Advantage |  |
| Imperial Health Plan of the Southwest - Utah Exchange | Medical | UT | Commercial |  |
| Imperial Insurance Companies | Medical | TX | Commercial, Medicare Advantage |  |
| Imperial Insurance Companies - Nevada Exchange | Medical | NV | Commercial |  |
| Imperial Insurance Companies Inc - Arizona Exchange | Medical | AZ | Commercial |  |
| Imperial Insurance Companies Inc - Texas Exchange | Medical | TX | Commercial |  |
| IMS | Medical | TX | Commercial |  |
| Indecs, a Homestead Company | Medical, Dental |  |  |  |
| Independence American Insurance Company | Medical, Dental |  | Commercial |  |
| Independent Clinics of Washington | Medical | WA | Medicaid, Medicare |  |
| Independent Health | Medical, Dental | NY | Commercial, Medicaid, Medicare Advantage |  |
| Independent Living Systems | Medical | Nationwide |  |  |
| Independent Living Systems (Independent Living Services Lead Agency) | Medical | FL |  |  |
| Indian Health Services | Medical |  |  |  |
| Indiana Department of Health Childrens Health Claims | Medical | IN |  |  |
| Indiana Medicaid | Medical, Dental, Vision | IN | Medicaid |  |
| Indiana University Health Plan - Medicare Advantage | Medical, Dental | IN | Medicare Advantage |  |
| Indiana University Health Plans - Commercial | Medical | IN | Commercial |  |
| Individual Assurance Company Life | Medical |  | Medicare |  |
| iNetico, Inc. (Valenz) | Medical, Dental |  | Commercial |  |
| Ingham Health Plan Corporation | Medical | MI |  |  |
| Inland Empire Health Plan (Covered California) | Medical | CA | Medicaid, Medicare Advantage |  |
| Inland Faculty Medical Group | Medical | CA | Commercial |  |
| Innermark TPA | Medical, Dental |  |  |  |
| Innovate OSF Healthcare Central | Medical | IL |  |  |
| Innovative Integrated Health | Medical | CA | Medicaid, Medicare |  |
| Insight Benefit Administrators | Medical |  |  |  |
| Insight Benefit Administrators | Medical |  | Commercial |  |
| InStil Health | Medical | SC | Commercial |  |
| Insurance Design Administrators | Medical |  | Commercial |  |
| Insurance Management Administrators Louisiana Incorporated | Medical | LA | Commercial |  |
| InsuranceTPA.com | Medical |  | Commercial |  |
| Insurica | Medical |  | Workers' Compensation |  |
| Integra Administrative Group | Medical, Dental, Vision |  | Commercial |  |
| Integra Partners | Medical |  | Commercial |  |
| Integrated Health Partners (IHP) | Medical |  | Commercial |  |
| Integrated Payor Solutions | Medical |  | Commercial |  |
| Interactive Medical Systems | Medical, Dental | AZ, CA, ID, NV, OR, WA |  |  |
| Intercare Health Plans Incorporated | Medical |  |  |  |
| International Brotherhood of Boilermakers Employee Health Care Plan | Medical |  | Commercial |  |
| International Brotherhood of Electrical Workers Local 38 | Dental | OH | Commercial |  |
| International Medical Group | Medical |  | Commercial |  |
| InterWest Health Preferred Provider Organization Montana | Medical | ID, MT, NE, ND, SD, UT, WA, WY | Commercial |  |
| INTotal Health | Medical | VA | Medicaid |  |
| Invicta Health Solutions | Medical |  |  |  |
| Iowa Health Advantage | Medical, Vision | IA | Medicare Advantage |  |
| Iowa Screening Program | Medical | IA |  |  |
| IPMG | Medical |  | Commercial |  |
| Iqvia | Medical |  |  |  |
| Iron Road Healthcare | Medical, Dental |  | Commercial |  |
| ISO International Student Health Insurance | Medical | Nationwide |  |  |
| iSurity | Medical | GA, KY, NC, PA, SC, TN, VA | Workers' Compensation |  |
| J. B. Hunt Transport Incorporated | Medical |  |  |  |
| J.P. Farley | Medical |  | Commercial |  |
| Jai Medical Systems | Medical, Dental | MD | Medicaid |  |
| Jan Werner PACE | Medical, Dental | TX | Medicaid, Medicare |  |
| Jericho Share | Medical, Dental |  | Commercial |  |
| John Hopkins Home Care Group | Medical | MD, DC, VA |  |  |
| John Morrell | Medical | SD, IA, NE | Commercial |  |
| John Muir Health Network | Medical | CA | Commercial |  |
| John Muir Trauma Physicians | Medical | CA | Commercial |  |
| Jordan Valley Senior Care | Medical, Dental | MO | Medicaid, Medicare |  |
| JPS Connection | Medical | TX |  |  |
| Judi Health | Medical |  |  |  |
| Kaiser CSI California Select for Individuals | Medical, Vision | CA | Commercial |  |
| Kaiser Foundation Health Plan Colorado | Medical, Dental, Vision | CO | Commercial, Medicaid, Medicare Advantage |  |
| Kaiser Foundation Health Plan Georgia | Medical, Dental, Vision | GA | Commercial, Medicaid, Medicare Advantage |  |
| Kaiser Foundation Health Plan Hawaii | Medical, Dental, Vision | HI | Commercial, Medicaid, Medicare Advantage |  |
| Kaiser Foundation Health Plan Mid-Atlantic | Medical, Dental, Vision | MD, VA, DC | Commercial, Medicare Advantage |  |
| Kaiser Foundation Health Plan Northern California | Medical, Vision | CA | Commercial, Medicaid, Medicare Advantage |  |
| Kaiser Foundation Health Plan Northwest | Medical, Dental, Vision | OR, WA | Commercial, Medicare Advantage |  |
| Kaiser Foundation Health Plan Southern California | Medical, Vision | CA | Commercial, Medicaid, Medicare Advantage |  |
| Kaiser Foundation Health Plan Washington | Medical, Dental, Vision | ID, WA | Commercial, Medicaid, Medicare Advantage |  |
| Kalos Health | Medical | NY | Medicaid |  |
| Kansas City Life Group Benefits | Medical, Dental |  | Commercial |  |
| Kansas Health Advantage | Medical | KS | Medicare Advantage |  |
| Kaweah Delta Medicare Advantage | Medical | CA | Medicare |  |
| Keenan and Associates | Medical | CA |  |  |
| Keenan and Associates (Excluding City of Pasadena) | Medical |  | Workers' Compensation |  |
| Kelly Benefits | Medical |  | Commercial |  |
| Kemper Preferred | Medical |  | Commercial |  |
| Kempton Group | Medical, Dental, Vision |  | Commercial |  |
| Kentucky Health Administrators | Medical |  | Commercial |  |
| Kern County Health & Wellness | Medical | CA | Commercial |  |
| Kern Family Health Care | Medical, Dental | CA | Medicaid, Medicare Advantage |  |
| Kern Legacy Health Plans | Medical | CA | Commercial |  |
| Key Benefit Administrators | Medical, Dental, Vision |  | Commercial |  |
| Key Benefit Administrators | Medical, Dental, Vision | IN |  |  |
| Key Health Medical Solutions Incorporated | Medical |  |  |  |
| Kindbody | Medical |  | Commercial |  |
| Klais and Company (Part A and Part B) | Medical |  |  |  |
| Klarity Health | Medical |  |  |  |
| Klyre | Medical |  | Commercial |  |
| KM Strategic Management | Medical | CA | Commercial |  |
| Know The Costs | Medical |  |  |  |
| Koan Risk Solutions | Medical, Dental | HI | Medicaid |  |
| Kopp Billing Agency Inc. | Medical |  |  |  |
| Kova Healthcare Incorporated | Medical | CA | Medicare |  |
| KSKJ Life | Vision | Nationwide |  |  |
| Kuspuk School District | Medical | AK |  |  |
| LA Department of Water and Power | Medical | CA | Workers' Compensation |  |
| Lagniappe Advantage | Medical | LA | Medicare Advantage |  |
| Lake Area Community Health Plan | Medical |  |  |  |
| Lakeside Community Healthcare | Medical | CA | Commercial |  |
| Lakeside Medical Group | Medical | CA | Commercial |  |
| Landmark Healthplan | Medical | CA | Commercial |  |
| Lantern Care | Medical |  | Commercial |  |
| LaSalle Medical Associates | Medical | CA | Commercial |  |
| Lassen Municipal Utility District | Medical | CA | Commercial |  |
| Leading Edge Administrators | Medical |  | Commercial |  |
| Leon Health Plan | Medical | FL | Medicare Advantage |  |
| Liberty Advantage North Carolina | Medical | NC | Medicaid, Medicare Advantage |  |
| Liberty HealthShare | Medical |  |  |  |
| Life Beaver PACE | Medical, Dental | PA | Medicaid, Medicare Advantage |  |
| Life St. Francis | Medical | NJ | Medicaid, Medicare |  |
| Life St. Joseph of the Pines | Medical, Dental | NC | Medicaid, Medicare |  |
| LifeCircles PACE | Medical | MI | Medicaid, Medicare |  |
| LifeMap | Dental |  |  |  |
| LifeShield National Insurance Co. | Medical |  | Medicare |  |
| LifeWise Health Plan of Washington | Medical, Dental, Vision | WA | Commercial |  |
| LINECO | Medical, Dental |  | Commercial |  |
| Live Well IPA | Medical |  |  |  |
| Lockard Williams Insurance Services (90 Degree Benefits) | Medical, Dental |  | Commercial |  |
| Loma Linda University Adventist | Medical | CA | Commercial |  |
| Loma Linda University Managed Care | Medical | CA | Commercial |  |
| Longevity Health Colorado | Medical, Dental | CO | Medicare Advantage |  |
| Longevity Health Florida | Medical, Dental | FL | Medicare Advantage |  |
| Longevity Health Illinois | Medical, Dental | IL | Medicare Advantage |  |
| Longevity Health Massachusetts | Medical | MA | Medicare Advantage |  |
| Longevity Health Michigan | Medical, Dental | MI | Medicare Advantage |  |
| Longevity Health New Jersey | Medical, Dental | NJ | Medicare Advantage |  |
| Longevity Health New York | Medical, Dental | NY | Medicare Advantage |  |
| Longevity Health North Carolina | Medical, Dental | NC | Medicare Advantage |  |
| Loren Cook | Medical | MO | Commercial |  |
| Louisiana State University | Medical | LA | Workers' Compensation |  |
| Loyola Physician Partners | Medical | IL | Commercial |  |
| Lucet | Medical |  |  |  |
| Lumico Life Insurance Company | Medical, Dental, Vision |  | Medicare |  |
| Luminare Health | Medical, Dental, Vision | AZ, IL, IN, MD, MN, NC, PA |  |  |
| Luminare Health Detroit | Medical, Dental, Vision |  | Commercial |  |
| Luminare Health Internal | Medical, Dental, Vision | OH |  |  |
| Luminare Health Kansas City | Medical, Dental, Vision |  |  |  |
| Luminare Health Little Rock | Medical, Dental, Vision | AR | Commercial |  |
| Luminare Health Ohio | Medical, Dental, Vision | OH | Commercial |  |
| Lummi Indian Business Council | Medical |  |  |  |
| Lutheran Advanced PPO | Medical | IN | Commercial |  |
| Lutheran Preferred | Medical |  | Commercial |  |
| LWCC | Medical | LA | Workers' Compensation |  |
| Lyra Clinical Associates | Medical |  |  |  |
| Magellan Health | Medical, Dental |  | Commercial |  |
| Maine Medicaid | Medical, Dental, Vision | ME | Medicaid |  |
| Managed Care Services | Medical, Dental |  | Commercial |  |
| Managed DentalGuard | Dental | Nationwide | Commercial |  |
| Managed Health Networks (MHN - Non Behavioral Health Services) | Medical, Dental |  | Medicaid |  |
| Managed Provider Alliance - Custom Provider Network | Medical, Dental |  |  |  |
| ManhattanLife | Medical, Dental, Vision |  | Commercial |  |
| ManhattanLife Supplemental Medical Expense Plan | Medical |  | Commercial |  |
| MAPFRE | Medical, Dental, Vision | PR | Commercial |  |
| March Vision Care | Medical, Vision |  |  |  |
| Marin Headlands Medical Group | Medical | CA | Commercial |  |
| Marpai Health | Medical, Dental | Nationwide |  |  |
| Marrick Mement Finance | Medical |  |  |  |
| Martin's Point | Medical, Vision | ME, NH | Medicare Advantage, TRICARE |  |
| Maryland Public Behavioral Health System (PBHS) | Medical, Dental | MD | Medicaid |  |
| Mashantucket Pequot Tribal Nation | Medical, Dental | CT |  |  |
| Mass Advantage | Medical | MA | Medicare Advantage |  |
| Massachusetts Behavioral Health Partnership | Medical, Dental | MA | Medicaid |  |
| Mayo Clinic Recovery and Claims Services | Medical |  | Workers' Compensation |  |
| MBA Benefit Administrators | Medical |  | Commercial |  |
| McLaren Community – Commercial HMO/POS | Medical, Dental | IN, MI | Commercial |  |
| McLaren Health Advantage | Medical, Dental | MI | Commercial |  |
| McLaren Health Plan (K7) - JVHL | Medical | MI | Commercial |  |
| McLaren Medicaid/Healthy Michigan Plan | Medical, Dental | MI | Medicaid |  |
| McLaren Medicare (MA) | Medical | MI | Medicare Advantage |  |
| McLaren Medicare Supplemental | Medical | MI | Medicare |  |
| MCNA Dental | Dental | PA | Medicaid |  |
| MCS | Medical, Dental, Vision | PR | Commercial, Medicare Advantage |  |
| MD Senior Care Medical Group | Medical | CA | Commercial |  |
| MDsave | Medical |  | Commercial |  |
| MDwise (Healthy Indiana Plan) | Medical, Dental, Vision | IN | Medicaid |  |
| MDwise (Hoosier Healthwise) | Medical, Dental, Vision | IN | Medicaid |  |
| Med Point Management Prospect (MPM) | Medical | CA | Commercial |  |
| MedBen | Medical, Dental, Vision |  | Commercial |  |
| MedBen | Medical, Dental, Vision |  | Commercial |  |
| MedCore Health Plan | Medical | CA |  |  |
| MedCost | Medical, Dental, Vision |  | Commercial |  |
| MedCost Benefit Services | Medical, Dental, Vision | NC | Commercial |  |
| Medequip Inc | Medical |  |  |  |
| Medi-Cal Dental | Dental | CA | Medicaid |  |
| Medica Health Plan Solutions | Medical, Vision | MN, MO, NE, ND, SD, WI | Commercial |  |
| Medica Health Plan Solutions | Medical | FL, GA | Commercial |  |
| Medicaid Alaska | Medical, Dental, Vision | AK | Medicaid |  |
| Medicaid Arizona | Medical, Dental | AZ | Medicaid |  |
| Medicaid Delaware | Medical, Dental | DE | Medicaid |  |
| Medicaid District of Columbia | Medical, Dental, Vision | DC | Medicaid |  |
| Medicaid Florida | Medical, Dental, Vision | FL | Medicaid |  |
| Medicaid Hawaii | Medical, Dental | HI | Medicaid |  |
| Medicaid Idaho | Medical, Dental | ID | Medicaid |  |
| Medicaid Illinois | Medical, Dental | IL | Medicaid |  |
| Medicaid Iowa | Medical, Dental, Vision | IA | Medicaid |  |
| Medicaid Kansas | Medical, Dental, Vision | KS | Medicaid |  |
| Medicaid Louisiana | Medical, Dental, Vision | LA | Medicaid |  |
| Medicaid Maryland | Medical, Dental | MD | Medicaid |  |
| Medicaid Massachusetts | Medical, Dental | MA | Medicaid |  |
| Medicaid Michigan | Medical, Dental, Vision | MI | Medicaid |  |
| Medicaid Michigan - BC3NP | Medical | MI | Medicaid |  |
| Medicaid Minnesota | Medical, Dental, Vision | MN | Medicaid |  |
| Medicaid Mississippi | Medical, Dental | MS | Medicaid |  |
| Medicaid Missouri | Medical, Dental, Vision | MO | Medicaid |  |
| Medicaid Montana | Medical, Dental, Vision | MT | Medicaid |  |
| Medicaid New Hampshire | Medical, Dental, Vision | NH | Medicaid |  |
| Medicaid New York | Medical, Dental, Vision | NY | Medicaid |  |
| Medicaid North Dakota | Medical, Dental | ND | Medicaid |  |
| Medicaid Oklahoma | Medical, Dental, Vision | OK | Medicaid |  |
| Medicaid Oregon | Medical, Dental, Vision | OR | Medicaid |  |
| Medicaid Pennsylvania | Medical, Dental | PA | Medicaid |  |
| Medicaid Rhode Island | Medical, Dental, Vision | RI | Medicaid |  |
| Medicaid South Dakota | Medical, Dental, Vision | SD | Medicaid |  |
| Medicaid Tennessee | Medical, Dental, Vision | TN | Medicaid |  |
| Medicaid United States Virgin Islands | Medical | VI | Medicaid |  |
| Medicaid Virginia | Medical, Dental, Vision | VA | Medicaid |  |
| Medicaid Wisconsin | Medical, Dental, Vision | WI | Medicaid |  |
| Medicaid Wyoming | Medical, Dental, Vision | WY | Medicaid |  |
| Medical Associates Health Plan Health Choices | Medical, Dental | IA | Commercial, Medicare Advantage |  |
| Medical Mutual | Medical, Dental, Vision | OH, WI | Commercial, Medicare Advantage |  |
| Medical Service Initiative Orange County | Medical | CA |  |  |
| Medicare Advantage Pennsylvania | Medical | PA |  |  |
| Medicare Durable Medical Equipment Regional Carrier Jurisdiction A | Medical, Dental | CT, DE, ME, MD, MA, NH, NJ, PA, RI, VT, DC | Medicare |  |
| Medicare Durable Medical Equipment Regional Carrier Jurisdiction B | Medical, Dental | IL, IN, KY, MI, MN, OH, WI | Medicare |  |
| Medicare Durable Medical Equipment Regional Carrier Jurisdiction C | Medical, Dental, Vision | AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, PR, VI | Medicare |  |
| Medicare Durable Medical Equipment Regional Carrier Jurisdiction D | Medical, Dental | AK, AZ, CA, HI, ID, IA, KS, MO, MT, NE, NV, ND, OR, SD, UT, WA, WY, GU, AS, MP | Medicare |  |
| Medicare Part A J04911 | Medical |  | Medicare |  |
| Medicare Part A Legacy WPS (Colorado New Mexico Texas Oklahoma) | Medical, Dental | CO, NM, OK, TX | Medicare |  |
| MediChoice Independent Practice Association | Medical | CA | Commercial |  |
| Medico Insurance Company | Medical, Dental, Vision |  | Medicare |  |
| MediStreams | Medical |  |  |  |
| Mediview CMSEB UB | Medical | CA | Commercial |  |
| MedLogix Managed Service Organization - Americo Independent Practice Association | Medical | CA | Commercial |  |
| MedMutual Protect | Medical, Dental, Vision |  | Commercial |  |
| MedPartners | Medical |  | Commercial |  |
| MedPartners Administrative Services | Medical |  | Commercial |  |
| MedRisk | Medical |  | Workers' Compensation |  |
| MedSolutions Incorporated (Evicore) | Medical |  |  |  |
| MEMIC | Medical | ME | Workers' Compensation |  |
| Memorial Hermann Health Insurance Company | Medical | TX | Commercial, Medicare Advantage |  |
| MemorialCare Medical Foundation | Medical |  |  |  |
| MemorialCare Medical Foundation (Cap Services) | Medical | CA |  |  |
| MemorialCare Medical Foundation (UC Irvine) | Medical | CA |  |  |
| MemorialCare Select Health Plan | Medical | CA | Medicaid |  |
| MemorialCare Select Health Plan Encounters | Medical | CA | Commercial, Medicare Advantage |  |
| Mendota Insurance Company | Medical | FL |  |  |
| Mental Health Consultants | Medical |  |  |  |
| Mercalis | Medical |  |  |  |
| Merchants Benefit Administration | Medical, Dental |  | Commercial |  |
| Merchants Benefit Administration | Medical |  | Commercial |  |
| Merchants Benefit Administration | Medical |  | Commercial |  |
| Meridian PACE Solutions | Medical |  | Medicaid, Medicare |  |
| Meritage Medical Network – Central Valley | Medical | CA | Medicare |  |
| Meritage Medical Network – NorCal  | Medical | CA | Commercial |  |
| MetroPlusHealth | Medical, Dental | NY | Commercial, Medicaid, Medicare Advantage |  |
| MFC and HealthPlus Peoria | Medical | IL |  |  |
| Michigan Laborers’ Fringe Benefit Funds | Medical | MI | Commercial |  |
| Mid America Associates Incorporated | Medical |  | Commercial |  |
| Midlands Choice | Medical | IA, NE, SD | Commercial |  |
| Midwest Family Mutual (Auto Only) | Medical | AZ, CO, ID, IL, IN, IA, KS, MN, MO, MT, NE, ND, OH, OR, SD, UT, WI | Automobile medical |  |
| Midwest Operating Engineers Fringe Benefit Funds | Dental |  | Commercial |  |
| Midwest Operating Engineers Welfare Fund | Medical | IL | Commercial |  |
| Millette Administrators Inc. (Michigan) | Medical, Dental |  |  |  |
| Millette Administrators, Inc. | Medical, Dental |  |  |  |
| Minnesota Department of Health | Medical | MN |  |  |
| MinuteMen OhioComp | Medical | OH | Workers' Compensation |  |
| Mirra Health Care | Medical |  | Commercial, Medicare Advantage |  |
| Mishe Health | Medical |  |  |  |
| Mission Community IPA Medical Group | Medical | CA | Commercial |  |
| Mississippi CHIP | Medical | MS | Medicaid |  |
| Mississippi Physicians Care Network | Medical | MS | Commercial |  |
| Missoula County Medical Benefits | Medical | MT | Commercial |  |
| MMM | Medical | PR | Medicare Advantage |  |
| MMM Healthcare | Medical, Dental, Vision | PR | Medicare Advantage |  |
| MMM Multihealth | Medical, Dental | PR | Medicaid, Medicare Advantage |  |
| Moda Health Plan | Medical, Dental, Vision | AK, ID, OR, TX | Medicaid |  |
| Modivcare | Medical |  |  |  |
| Momentum TPA | Medical |  | Commercial |  |
| Montgomery County Self Insurance Program | Medical | MD | Workers' Compensation |  |
| Motion Picture Industry Pension and Health Plans | Medical |  | Commercial, Medicare Advantage |  |
| MotivHealth | Medical, Dental | AZ, CO, IN, NV, TX, UT | Commercial |  |
| Mount Carmel MediGold | Medical, Dental | OH | Medicare Advantage |  |
| Mount Sinai Eldercare  | Medical, Dental | FL | Medicaid, Medicare |  |
| Mountain Health Co-op | Medical, Dental, Vision | ID, MT, WY | Commercial |  |
| Movedocs.com llc | Medical |  |  |  |
| MPE Employee Benefit Services Incorporated | Medical |  |  |  |
| MS Administrative Services  | Medical, Dental |  | Commercial |  |
| MSA Care Guard | Medical |  |  |  |
| MultiCare Connected Care | Medical | WA | Medicare |  |
| MultiCare PACE | Medical, Dental | WA | Medicaid, Medicare |  |
| Multnomah County | Medical | OR |  |  |
| Municipal Health Benefit Program | Medical, Dental | AR | Commercial |  |
| Mutual Assurance Administrators | Medical, Dental |  | Commercial |  |
| Mutual Health Services | Medical, Dental, Vision | OH |  |  |
| MVP Health Care | Dental | NY | Commercial, Medicaid, Medicare Advantage |  |
| MVP Health Care | Medical, Dental, Vision | AZ, FL, NY, PA, SC, VT | Commercial, Medicaid, Medicare |  |
| My Choice Wisconsin | Medical | WI | Medicaid |  |
| My Family Medical Group | Medical | CA | Commercial |  |
| MyTruAdvantage | Medical | IN | Medicare Advantage |  |
| NAHGA | Medical |  | Commercial |  |
| NALC Health Benefit Plan | Medical, Dental | Nationwide | Commercial |  |
| NaphCare | Medical | Nationwide |  |  |
| Nascentia Health | Medical | NY | Medicaid, Medicare Advantage |  |
| Nassau | Medical, Dental, Vision |  | Medicare |  |
| National Asbestos Workers Medical Fund | Medical, Dental |  | Commercial |  |
| National Association of Letter Carriers (NALC) | Medical, Dental, Vision |  |  |  |
| National Centers for Medicare & Medicaid Services | Medical, Dental, Vision | Nationwide | Medicare |  |
| National Elevator Industry Benefit Plans | Dental |  | Commercial |  |
| National Foundation Life Insurance Company | Medical, Dental | AL, AZ, AR, CO, DE, FL, GA, IL, IN, IA, KS, KY, LA, MD, MI, MS, MO, MT, NE, NV, NC, OH, OK, PA, SC, SD, TN, TX, UT, VA, WV, WI, WY | Commercial |  |
| National General - Worker Compensation | Medical |  |  |  |
| National Health Administrators | Medical |  | Commercial |  |
| National Health Benefit Corporation Auxiant | Medical, Dental |  | Commercial |  |
| National Telecommunications Cooperative Association | Medical, Dental |  | Commercial |  |
| National Vision Administrators | Medical, Vision |  | Commercial, Medicaid |  |
| Nations Vision | Medical, Vision |  |  |  |
| Nationwide | Medical | Nationwide | Workers' Compensation |  |
| Native Care Health LLC | Medical |  |  |  |
| NAWU Local 831 | Medical |  | Commercial |  |
| NCAS | Medical, Dental, Vision |  | Commercial |  |
| NEBA | Medical |  | Commercial |  |
| Nebraska Medicaid | Medical | NE | Medicaid |  |
| NeighborHealth | Medical | MA | Medicaid, Medicare |  |
| Neighborhood Health Partnership | Medical | FL | Commercial |  |
| Neighborhood Health Plan of Rhode Island (INTEGRITY) | Medical | RI | Medicaid, Medicare Advantage |  |
| Neighborhood Health Plan of Rhode Island (Medicaid/Commercial) | Medical | RI | Medicaid, Medicare Advantage |  |
| Neighborhood Healthcare PACE | Medical, Dental | CA | Medicaid, Medicare |  |
| NetCare Life and Health Insurance | Medical | GU, FM | Commercial |  |
| Network Solutions Independent Practice Association | Medical | NY | Commercial |  |
| Nevada Dental Benefits | Dental | NV | Commercial |  |
| New Avenues Incorporated | Medical |  |  |  |
| New Era Life Insurance | Medical, Dental, Vision | NE, TX | Medicare |  |
| New Horizons PACE | Medical, Dental | MO | Medicaid, Medicare |  |
| New Jersey Manufacturing | Medical | NJ | Automobile medical |  |
| New Jersey Manufacturing - Workers' Compensation | Medical | NJ | Workers' Compensation |  |
| New York Black Car Fund | Medical | NY |  |  |
| New York City Employees (NYCE) PPO Plan | Medical, Vision | NY | Commercial |  |
| New York Hotel Trade Council | Medical | NY | Commercial |  |
| New York Life | Medical |  |  |  |
| New York Medical Indemnity Fund | Medical | NY |  |  |
| New York Network Management | Medical | NY | Commercial |  |
| New York State Department of Health Uninsured Care Programs | Medical | NY | Medicaid |  |
| Nexillo Health | Medical |  | Commercial |  |
| Next Generation MyCare Ohio - CareSource | Medical, Dental, Vision | OH | Medicaid |  |
| Next Generation MyCare Ohio - Molina | Medical, Dental, Vision | OH | Medicaid, Medicare Advantage |  |
| NextBlue of North Dakota | Medical, Vision | ND | Medicare Advantage |  |
| Nippon Life Insurance Company | Medical, Dental, Vision |  |  |  |
| NJ FamilyCare | Medical, Dental, Vision | NJ | Medicaid |  |
| Nomi Health Gateway | Medical |  |  |  |
| North American Administrators Nashville, Tennessee (Lucent Health) | Medical, Dental, Vision |  | Commercial |  |
| North American Insurance Company (Oxford Life) | Medical, Vision |  | Medicare |  |
| North Bay Schools Insurance Authority (NBSIA) | Medical |  | Workers' Compensation |  |
| North Carolina Department of Public Safety | Medical | NC |  |  |
| North Carolina Farm Bureau | Medical | NC | Workers' Compensation |  |
| North Carolina Health Choice | Medical | NC | Medicaid |  |
| North Carolina Medicaid | Medical, Dental, Vision | NC | Medicaid |  |
| NorthCoast Health Care Management | Medical |  |  |  |
| Northcoast Healthcare | Medical |  |  |  |
| Northeast Iowa Area Agency | Medical | IA |  |  |
| Northern California Pipe Trades Trust Funds | Dental | CA | Commercial |  |
| Northern Illinois Health Plan | Medical | IL | Commercial |  |
| Northern Plains Providence Health Plan OHP | Medical | OR | Medicaid |  |
| Northland Auto | Medical |  | Automobile medical |  |
| Northwell Direct | Medical | NY | Commercial |  |
| Northwest Administrators | Medical, Dental | CA, NV, OR, WA | Commercial |  |
| Northwest Administrators | Medical | NV | Commercial |  |
| Northwest Dental Services | Dental |  |  |  |
| Northwest Suburban IPA Illinois (CCMSI) | Medical |  | Commercial |  |
| Northwood Healthcare | Medical |  | Commercial |  |
| Nova Healthcare Administrators | Medical, Dental, Vision | NY | Commercial |  |
| NovaOne | Medical | Nationwide | Commercial |  |
| NueHealth | Medical |  |  |  |
| NYC Law Department – Workers Compensation | Medical | GA, NJ, NY | Workers' Compensation |  |
| NYSIF | Medical | NY |  |  |
| NYSIF – Workers Compensation | Medical | NY | Workers' Compensation |  |
| O'Reilly Auto Parts | Medical |  | Workers' Compensation |  |
| Oak Street Health | Medical |  | Commercial |  |
| Ochsner Health Plan | Medical, Dental | LA | Medicaid, Medicare |  |
| Ogden & Co. | Medical, Dental |  | Commercial |  |
| Ohio Bureau for Children with Medical Handicps (BCMH) | Medical | OH |  |  |
| Ohio Casualty Group | Medical |  |  |  |
| Ohio Department of Aging | Medical | OH | Medicaid, Medicare |  |
| Ohio Medicaid Buckeye Vision | Medical, Vision | OH | Medicaid |  |
| Ohio PPO Connect | Medical | OH | Commercial |  |
| OhioHealthy | Medical, Vision | OH | Commercial |  |
| Oklahoma Department of Corrections | Medical, Dental, Vision | OK |  |  |
| Old Surety Life | Medical | OK | Medicare |  |
| OmniCare Medical Group (Omni) | Medical | CA |  |  |
| On Lok PACE  | Medical | CA | Medicaid, Medicare |  |
| One Call | Medical |  | Workers' Compensation |  |
| One Call | Medical |  | Commercial |  |
| One Health Plan California | Medical |  | Commercial |  |
| One Health Plan of Georgia | Medical | GA |  |  |
| One HomeCare Solutions | Medical |  |  |  |
| OneBeacon | Medical |  | Workers' Compensation |  |
| OneDigital | Dental |  | Commercial |  |
| OPEIU Locals 30 & 537 Trust Funds | Medical |  | Commercial |  |
| Operating Engineers Local 139 Health Benefit Fund | Medical | WI | Commercial |  |
| OptiMedHealth | Medical |  | Commercial |  |
| Optimum Healthcare | Medical | FL | Medicare Advantage |  |
| Optum | Medical |  |  |  |
| Optum Care Network | Medical, Dental |  |  |  |
| Optum San Diego Public Sector | Medical | CA | Medicaid |  |
| Optum San Diego Public Sector Behavioral Health | Medical | CA | Medicaid |  |
| OptumHealth Physical Health | Medical | Nationwide | Commercial |  |
| Oracle | Medical |  | Commercial |  |
| Orange County Correctional Health Services | Medical | CA |  |  |
| Orange County Health Care Agency - Ryan White Program | Medical, Dental | CA |  |  |
| OrchestrateHR | Medical | TX |  |  |
| OrchestrateHR Florida | Medical | FL, TX |  |  |
| OrchestrateHR SF | Medical | CA, TX |  |  |
| Oregon Health Authority - HRSN | Medical | OR | Medicaid |  |
| Orthonet Uniformed Services Family Health Plan | Medical | CT, ME, MA, NH, NY, OH, PA, RI, VT |  |  |
| Oscar Health | Medical, Dental | AL, AZ, FL, GA, IL, IA, KS, MI, MS, MO, NE, NJ, NY, NC, OH, OK, PA, TN, TX, VA | Commercial |  |
| Oxbridge Health | Medical | Nationwide | Commercial |  |
| Oxford Life Insurance | Medical, Dental |  | Medicare |  |
| P3 Health Partners Arizona | Medical | AZ |  |  |
| P3 Health Partners Nevada | Medical | AZ, NV, OR, CA, NE |  |  |
| PACE at Hudson Headwaters | Medical, Dental | NY | Medicaid, Medicare |  |
| PACE at LCHC | Medical, Dental | IL | Medicaid, Medicare |  |
| PACE by Innercare | Medical, Dental | CA | Medicaid, Medicare |  |
| PACE Central New York | Medical, Dental | NY | Medicaid, Medicare |  |
| PACE Greater New Orleans | Medical | LA | Medicaid, Medicare |  |
| PACE KC | Medical, Dental | MO | Medicaid, Medicare |  |
| PACE Northeast Michigan | Medical, Dental | MI | Medicaid, Medicare |  |
| PACE of Southwest Michigan | Medical | MI | Medicaid, Medicare |  |
| PACE of SouthWest Michigan | Medical, Dental | MI | Medicaid, Medicare |  |
| PACE of the Triad | Medical, Dental | NC | Medicaid, Medicare |  |
| PACE Southeast Michigan | Medical, Dental | MI | Medicaid, Medicare |  |
| PACE Your LIFE | Medical, Dental | DE | Medicaid, Medicare |  |
| Pacific Administrators | Medical | HI | Commercial |  |
| Pacific Life | Dental, Vision |  | Commercial |  |
| Pacific Partners Management Services | Medical |  | Commercial |  |
| Pacific Southwest Administrators | Medical |  | Commercial |  |
| Pacific Union Dental | Dental |  | Commercial |  |
| Pacifica of the Valley Hospital | Medical |  | Commercial |  |
| PacificSource Community Solutions | Medical, Dental | OR | Medicaid |  |
| PAI | Medical | CA | Commercial |  |
| Painter's Union Insurance, Pension & Vacation Funds | Medical |  | Commercial |  |
| Pan-American Life Insurance Group | Medical, Dental |  |  |  |
| Panorama | Medical | IL | Medicaid, Medicare |  |
| Paragon Benefits | Medical |  | Commercial |  |
| Paramount | Medical, Dental, Vision | MI, OH | Commercial, Medicaid, Medicare Advantage |  |
| Partners Health Management (Behavioral Health) | Medical, Dental, Vision | NC | Medicaid |  |
| Partners Health Plan | Medical | NY |  |  |
| Partnership HealthPlan of California | Medical | CA | Medicaid |  |
| Passport by Molina Healthcare | Medical | KY | Medicare |  |
| Patient Advocates | Medical, Dental |  | Commercial |  |
| PayerFusion | Medical, Dental |  |  |  |
| PaySign | Medical |  |  |  |
| PBS | Medical | OR | Commercial |  |
| PBS Oregon Alaska Industrial Hardware | Medical, Dental | AK | Commercial |  |
| PBS Oregon Alaska Rubber and Supply | Medical, Dental |  | Commercial |  |
| PBS Oregon Cascade Rubber Products | Medical, Dental | OR | Commercial |  |
| PBS Oregon Construction Machinery Industrial | Medical, Dental | AK | Commercial |  |
| Peak Health | Medical, Vision | KY, PA, WV | Commercial |  |
| PEHP | Medical, Dental, Vision | UT | Commercial |  |
| Pekin Insurance | Medical, Dental | AZ, GA, IL, IN, IA, KS, LA, MI, MS, MO, NE, OH, TN, TX, WI | Commercial, Medicare |  |
| Pennsylvania Manufacturing Associates | Medical |  | Workers' Compensation |  |
| People One Health | Medical | FL | Commercial |  |
| Perennial Advantage of Colorado | Medical | CO | Medicare Advantage |  |
| PerformCare | Medical, Vision | PA | Medicaid |  |
| Personify Health | Medical, Dental | CA |  |  |
| Personify Health | Medical, Dental, Vision | LA |  |  |
| Personify Health | Medical, Dental, Vision |  |  |  |
| Personify Health Solutions LLC | Medical, Dental |  |  |  |
| PHC California | Medical | CA | Medicaid, Medicare Advantage |  |
| PHP | Medical, Dental | CA | Medicaid, Medicare |  |
| Physicians Care Network Rockford Illinois | Medical | IL |  |  |
| Physicians Choice Medical Group San Luis Obispo | Medical |  | Commercial |  |
| Physicians DataTrust | Medical | CA | Commercial, Medicaid, Medicare |  |
| Physicians Health Plan Third Party Administrator Services | Medical | IN | Commercial |  |
| Physicians Medical Group of San Jose | Medical | CA | Commercial |  |
| Physicians Mutual Insurance Company | Medical, Dental, Vision | IN | Commercial, Medicare |  |
| Physmetrics | Medical |  | Commercial |  |
| Piedmont Community Health Plan | Medical | VA | Commercial |  |
| Pinnacle Claims Management Inc. | Medical, Dental, Vision |  |  |  |
| Pipe Fitters' Local 597 Welfare Fund | Dental | IL | Commercial |  |
| Plan de Bienestar UTM-PRSSA | Medical | PR | Commercial |  |
| Plan de Salud Hospital Menonita | Medical, Dental | PR | Commercial |  |
| Plan Medico Bella Vista | Medical, Dental | PR | Commercial |  |
| Planned Administrators Incorporated | Medical, Dental, Vision | Nationwide | Commercial |  |
| Plumbers Union Local No. 12 Welfare Fund | Medical |  | Commercial |  |
| PMC Government Health Plan GHP (Vital) | Medical, Dental | PR | Commercial |  |
| Point C (ARC Administrators) | Medical |  | Commercial |  |
| Point C (Insurance Administrator of America) | Medical, Dental | Nationwide |  |  |
| Point C (Med Pay) | Medical | MO | Commercial |  |
| Point C (Mid American Benefits) | Medical, Dental |  | Commercial |  |
| Point C (Point C Health) | Medical, Dental | Nationwide |  |  |
| Point C (Ultra Benefits) | Medical |  | Commercial |  |
| Point Comfort Correctional CARE | Medical, Dental |  |  |  |
| Point Comfort Underwriters - ORR Unaccompanied Childrens Programs | Medical, Dental | Nationwide |  |  |
| Point Comfort Underwriters Travel - PCG Travel Programs | Medical |  | Commercial |  |
| Pokagon Health Services | Medical | MI |  |  |
| Poly-America | Medical, Dental |  | Commercial |  |
| Pool Administrators (Oregon Secondary Claims) | Medical | OR | Medicaid |  |
| Pool Administrators Oregon Professional Primary | Medical |  |  |  |
| Populytics | Medical, Dental |  |  |  |
| Port of Oakland California | Medical | CA | Workers' Compensation |  |
| Porter Scott | Medical |  |  |  |
| Prairie States | Medical, Dental |  | Commercial |  |
| Preferred Administrators | Medical | TX | Commercial |  |
| Preferred Administrators | Medical, Dental | TX |  |  |
| Preferred Administrators Children's Hospital | Medical | TX | Medicaid, Medicare Advantage |  |
| Preferred Benefit Administrators | Medical |  | Commercial |  |
| Preferred Care Network | Medical, Dental, Vision | FL | Medicare Advantage |  |
| Preferred Care Partners | Medical, Dental, Vision | FL | Medicare Advantage |  |
| Preferred Community Choice | Medical | OK | Commercial, Medicare Advantage |  |
| Preferred Independent Physician Association | Medical | CA | Commercial |  |
| Preferred Provider Organization One | Medical |  |  |  |
| PreferredOne (Aspirus Health Plan) | Medical, Dental | CT, WI | Commercial, Medicare |  |
| Premier | Medical |  | Commercial |  |
| Premier Access Insurance (CA) | Dental |  |  |  |
| Premier Administrative Solutions | Medical |  |  |  |
| Premier Eye Care | Medical, Vision |  | Commercial |  |
| Premier Healthcare Exchange (Lucent Health) | Medical, Dental, Vision |  |  |  |
| Premier Healthcare Exchange (PHX) - Preferred Admin | Medical |  | Commercial |  |
| Premier Healthcare Exchange Incorporated (PHX) | Medical |  | Commercial |  |
| Premier Physicians Network | Medical |  | Commercial |  |
| Primary Care Associates of California | Medical |  |  |  |
| Prime Health Services | Medical | Nationwide | Commercial |  |
| PrimeSource Health Networks | Medical, Dental |  |  |  |
| PrimeWest Health | Medical, Dental | MN | Medicaid |  |
| Priority Health | Medical, Dental, Vision | MI | Commercial, Medicaid, Medicare Advantage |  |
| Prism Network Incorporated | Medical |  | Commercial |  |
| ProCare Advantage | Medical | TX | Medicare Advantage |  |
| Prodegi Corporate Benefit Service  | Medical | AK, ID, MT, ND, OR, SD, WA, WY | Commercial |  |
| Professional Benefit Administrators | Medical, Dental, Vision |  |  |  |
| Progressive | Medical |  | Workers' Compensation |  |
| Progressive Commercial Casualty Company | Medical | Nationwide | Workers' Compensation |  |
| Prominence Administrative Services | Medical, Dental | NV | Commercial, Medicare Advantage |  |
| Prospect Health | Medical |  | Commercial |  |
| PROSSAM | Medical | PR | Medicare |  |
| Protector 360 (Administered by Bay Bridge) | Medical |  | Commercial |  |
| Providence Health Assurance (Ayin) | Medical | OR | Medicaid, Medicare Advantage |  |
| Providence Health Assurance Medicare Supplement | Medical |  | Medicare |  |
| Providence Insurance and Administrative Services | Medical |  |  |  |
| Providence PACE | Medical, Dental | CA, OR, WA | Medicaid, Medicare |  |
| Provident Life & Accident Insurance Company of America | Dental |  |  |  |
| Provider Partners Health Plan of Illinois | Medical | IL | Medicare Advantage |  |
| Provider Partners Health Plan of Indiana | Medical | IN | Medicare Advantage |  |
| Provider Partners Health Plan of Maryland | Medical | MD | Medicare Advantage |  |
| Provider Partners Health Plan of Missouri | Medical | MO | Medicare Advantage |  |
| Provider Partners Health Plan of North Carolina | Medical | NC | Medicare Advantage |  |
| Provider Partners Health Plan of Ohio | Medical | OH | Medicare Advantage |  |
| Provider Partners Health Plan of Pennsylvania | Medical | PA | Medicare Advantage |  |
| Provider Partners Health Plan of Texas | Medical | TX | Medicare Advantage |  |
| ProviDRs Care | Medical |  | Commercial |  |
| Prudent Medical Group | Medical |  | Commercial |  |
| PruittHealth Premier of Georgia | Medical | GA | Medicare Advantage |  |
| PruittHealth Premier of North Carolina and South Carolina | Medical | NC, SC | Medicare Advantage |  |
| PSKW | Medical |  |  |  |
| Psychealth Care Management LLC | Medical |  |  |  |
| QBE General Casualty Freeport | Medical |  |  |  |
| Quad City Community Healthcare (QCCH) | Medical | IA | Commercial |  |
| QualCare Independent Practice Association | Medical | CA | Commercial |  |
| QualChoice Health Insurance | Medical, Dental | AR | Commercial |  |
| Qualexa Healthcare | Medical, Dental |  | Commercial |  |
| Quality Care Partners | Medical, Dental | OH | Commercial |  |
| Quartz | Medical, Dental, Vision | IL, IA, MN, WI | Commercial, Medicaid, Medicare Advantage |  |
| QUB | Medical |  |  |  |
| QuikTrip | Medical |  | Commercial |  |
| QuikTrip Corporation | Medical | IL, IN, IA, KS, MI, MN, MO, MT, NE, ND, OH, OK, SD, TX, UT |  |  |
| RCI | Medical |  | Commercial |  |
| Redirect Health Administration | Medical | Nationwide | Commercial |  |
| Redwood Coast PACE | Medical, Dental | CA | Medicaid, Medicare |  |
| Redwood Health Services | Dental | CA | Commercial |  |
| Reflect Health | Medical | Nationwide |  |  |
| Regal Medical Group | Medical | CA | Commercial |  |
| Regence Group Administrators | Medical, Dental, Vision | OR, WA | Commercial |  |
| Regency Employee Benefits | Medical |  | Commercial |  |
| Rehab Provider Network | Medical, Dental | Nationwide | Commercial |  |
| Rehn & Associates | Medical |  | Commercial |  |
| Reliance Global Group | Medical, Dental |  | Commercial |  |
| Reliance Matrix | Dental |  | Commercial |  |
| Reliance Matrix | Dental |  |  |  |
| Religious Order of Jehovah's Witness | Medical |  |  |  |
| Renaissance Life and Health | Medical | Nationwide |  |  |
| Renaissance Physicians | Medical | TX | Commercial |  |
| Republic Franklin Insurance | Medical | CT, DE, DC, GA, IL, IN, KS, MD, MA, MI, NH, NJ, NY, NC, OH, PA, RI, SC, TN, TX, VA, WI |  |  |
| Resurrection Physician Providers Group | Medical |  |  |  |
| Revecore | Medical |  | Commercial |  |
| RightCare | Medical | TX |  |  |
| Rincol Health Network | Medical | CA | Commercial |  |
| Robert F. Kennedy Medical Plan | Medical |  | Commercial |  |
| Rockford Mutual Insurance Company | Medical | IL, IN, MI, WI |  |  |
| Rocky Mountain PACE | Medical, Dental | CO | Medicaid, Medicare |  |
| Royal Neighbors of America | Medical, Vision | DC | Medicare |  |
| Rubicon Health Group | Medical | SC | Commercial |  |
| Ryder Services Incorporated | Medical |  |  |  |
| Ryder Services Incorporated - Worker Compensation | Medical |  |  |  |
| Safeco Insurance | Medical |  |  |  |
| Sagamore Health Network | Medical | IL, IN, KY, MI, OH | Commercial, Medicaid |  |
| Saint Joseph Heritage Healthcare | Medical |  |  |  |
| Samaritan Health Plans | Medical, Dental, Vision | OR | Commercial, Medicaid, Medicare |  |
| Samaritan Health Plans | Medical, Dental, Vision | OR | Commercial, Medicaid, Medicare Advantage |  |
| Samera Health  | Medical, Dental |  |  |  |
| San Diego County (Ryan White Care Act) | Medical | CA |  |  |
| San Diego County Medical Services (County Medical Services) | Medical | CA |  |  |
| San Diego County Physician Emergency Services | Medical | CA |  |  |
| San Diego PACE | Medical, Dental | CA | Medicaid, Medicare |  |
| San Francisco Health Plan | Medical, Vision | CA | Medicaid, Medicare Advantage |  |
| Santa Clara County Independent Practice Association Health Maintenance Organization | Medical | CA | Commercial |  |
| Santa Clara County IPA PPO | Medical | CA | Commercial |  |
| Santa Clara Valley Transportation Authority | Medical | CA | Workers' Compensation |  |
| Santa Monica Unite Here Health Benefit Plan | Medical | CA | Commercial |  |
| Sante Health System | Medical | CA | Medicaid |  |
| Saudi Health Mission | Medical |  |  |  |
| Savannah Business Group | Medical | GA | Commercial |  |
| SBMA | Medical |  | Commercial |  |
| Schaller Anderson Aetna Medicaid Texas and CHIP | Medical |  | Commercial, Medicaid |  |
| Schaller Anderson Mercy Care | Medical, Dental | AZ | Medicaid |  |
| SCHS Alta Global Medical Care Group | Medical |  | Commercial |  |
| Scion Dental (SKYGEN) | Dental | Nationwide |  |  |
| Scion Dental Commercial (SKYGEN) | Dental |  |  |  |
| Scippa - VHP Covered CARE | Medical | CA |  |  |
| Scripps Health Plan | Medical | CA | Commercial, Medicare |  |
| Scripps Health Plan Services | Medical | CA | Commercial, Medicare |  |
| SECUR Health Plan | Medical | FL | Medicare Advantage |  |
| SecureOne | Medical |  | Commercial |  |
| Security Administrative Services | Medical, Dental |  |  |  |
| Security Health Plan | Medical, Dental, Vision | WI | Commercial, Medicaid, Medicare Advantage |  |
| Sedgwick | Medical | Nationwide |  |  |
| Sedgwick – Workers Compensation | Medical | Nationwide | Workers' Compensation |  |
| Sedgwick Cargill Incorporated | Medical | Nationwide | Workers' Compensation |  |
| Sedgwick Claims Management Services | Medical | Nationwide | Workers' Compensation |  |
| Select Administrative Services | Medical, Dental | MS | Commercial |  |
| Selective | Medical | AL, AZ, CO, CT, DE, GA, IA, ID, IL, IN, KS, KY, MD, MA, ME, MI, MN, MO, MT, NV, NH, NJ, NM, NY, NC, OH, OR, PA, RI, SC, TN, UT, VA, VT, WA, WI, WV, WY, DC |  |  |
| Self Fund Health | Medical | WI, MN, IA, IL, MI | Commercial |  |
| Self Funded Plans | Medical |  | Commercial |  |
| SelmanCo | Medical | Nationwide | TRICARE, Veterans Affairs |  |
| SelmanCo | Medical | Nationwide |  |  |
| Sendero Health Plans | Medical | TX | Commercial |  |
| Senior Care Partners PACE | Medical, Dental | MI | Medicaid, Medicare |  |
| Senior CommUnity Care PACE | Medical | CO, KY, MD, MI, NC | Medicaid, Medicare |  |
| Senior Network Health | Medical | NY |  |  |
| Sentara PACE | Medical, Dental | VA | Medicaid, Medicare |  |
| Sentinel Security Life | Medical, Dental |  | Medicare |  |
| Sentry Auto | Medical | Nationwide | Automobile medical |  |
| Sentry Insurance | Medical | Nationwide | Workers' Compensation |  |
| Seoul Medical Group | Medical | CA, NY, NJ, GA, WA, HI | Commercial |  |
| Sequoia Health IPA | Medical | CA | Commercial |  |
| Seven Corners | Medical | Nationwide |  |  |
| SGIC | Medical | AL, AZ, AR, FL, GA, KY, LA, MS, NE, SC, TN, TX | Commercial |  |
| Share HealthCare | Medical |  | Commercial |  |
| Sharp Health Plan | Medical | CA | Commercial, Medicare Advantage |  |
| Sharp Health Plan | Medical | CA | Medicare |  |
| Sheet Metal Workers | Dental | MO |  |  |
| Shenandoah Life Insurance | Medical, Vision | VA | Medicare |  |
| Show Me Health Administrators | Medical |  | Commercial |  |
| Sidecar Health | Medical, Vision |  | Commercial |  |
| Sieba | Medical | NY | Commercial |  |
| SIHO Insurance Services | Medical, Vision | IN | Medicare Advantage |  |
| SIHRTE | Medical | CA | Commercial |  |
| Silver Star | Medical, Dental | TX | Medicaid, Medicare |  |
| SimplePay Health | Medical |  |  |  |
| Simplified Benefits Administrators | Medical | Nationwide | Commercial |  |
| Simpra Advantage | Medical, Vision | AL | Medicaid, Medicare Advantage |  |
| SISCO | Medical |  | Commercial |  |
| SISCO | Medical |  | Commercial |  |
| SISCO (Worker's Compensation) | Medical |  | Workers' Compensation |  |
| Skai Blue Cross Blue Shield | Medical, Dental, Vision | Nationwide | Commercial |  |
| Smith Administrators (Lucent Health) | Medical |  | Commercial |  |
| Snap-on Incorporated | Medical |  | Workers' Compensation |  |
| Snedeker Risk Management | Medical, Dental | IL |  |  |
| SNMIS (Safety Net Management Information System) | Medical | IA | Medicaid |  |
| SolarteHealth | Medical | MN, WI |  |  |
| Solidarity HealthShare | Medical | Nationwide |  |  |
| Solis Health Plans | Medical | FL | Medicare Advantage |  |
| Solstice | Medical, Dental | FL, GA, MD, NJ, NY, OH, PA | Commercial |  |
| SOMOS Innovation (Empire BCBS) | Medical | NY | Commercial |  |
| Sonder Health Plans | Medical, Dental | GA |  |  |
| South Atlantic Medical Group | Medical | CA | Commercial |  |
| South Coast Area Transit (California) | Medical | CA | Workers' Compensation |  |
| South Country Health Alliance | Medical, Dental | MN | Medicaid, Medicare Advantage |  |
| South Dakota All Women Count | Medical | SD |  |  |
| South Dakota Medicaid - STARS | Medical | SD | Medicaid |  |
| South Point Hotel & Casino | Medical | NV | Commercial |  |
| Southern California Edison | Medical | CA | Workers' Compensation |  |
| Southwest Airlines | Medical |  | Workers' Compensation |  |
| Southwest Michigan Behavioral Health (Mental Health) | Medical | MI | Medicaid |  |
| Southwest Michigan Behavioral Health (Substance Use Disorder) | Medical | MI | Medicaid |  |
| Southwest Service Administrators | Medical, Dental |  | Commercial |  |
| Southwest Service Life | Medical | TX | Commercial |  |
| Spencer Stuart (Advanced RISC Machines Ltd) | Medical |  | Commercial |  |
| St Luke Health Plan Inc | Medical, Vision | ID | Commercial |  |
| St Paul's PACE | Medical | CA | Medicaid, Medicare |  |
| St. Francis - Allcare by MedPoint | Medical |  | Commercial |  |
| St. Francis - HCLA by MedPoint | Medical |  | Commercial |  |
| Standard Life and Accident Insurance Company | Medical, Dental |  | Commercial |  |
| StarMed Administrators | Medical |  | Commercial |  |
| State Farm Insurance Companies | Medical, Dental |  | Medicare |  |
| State Farm Medicare Supplement | Medical, Dental |  | Medicare |  |
| State Fund | Medical | CA | Workers' Compensation |  |
| State Mutual | Medical | Nationwide |  |  |
| State of Idaho Women's Health Check | Medical | ID |  |  |
| State of North Carolina | Medical | NC | Workers' Compensation |  |
| State Of Texas Dental Plan | Medical, Dental, Vision | TX | Commercial |  |
| StayWell Guam | Medical | GU | Commercial |  |
| Stirling Benefits (90 Degree Benefits) | Medical, Dental | Nationwide | Commercial |  |
| SummaCare Health Plan | Medical, Dental | OH | Commercial, Medicare Advantage |  |
| Summit Administration Services | Medical, Dental |  | Commercial |  |
| Sunflower State Health Plan | Medical, Dental | KS | Medicaid |  |
| Sunrise PACE | Medical, Dental | MI | Medicaid, Medicare |  |
| Superior Insurance Services | Medical | CA | Commercial |  |
| Superior Vision | Medical, Vision |  | Commercial |  |
| Surego Administrative Services | Medical |  | Commercial |  |
| Sutter Connect - Sutter Gould Medical Foundation (SGMF) | Medical |  | Commercial |  |
| Sutter Health Aetna | Medical, Dental, Vision | CA | Commercial |  |
| Symetra | Medical | Nationwide | Commercial |  |
| Syntriq Health Solutions | Medical |  | Commercial |  |
| TakeCare Insurance Company | Medical | GU, MP | Commercial |  |
| Tall Tree Administrators | Medical | Nationwide |  |  |
| Tango | Medical | MI |  |  |
| TBR | Medical |  | Commercial |  |
| TeamCare | Medical, Dental |  | Commercial |  |
| Telus Health | Medical |  |  |  |
| Tethys Health Ventures | Medical |  |  |  |
| Texas Children's Health Plan | Medical | TX | Medicaid |  |
| Texas Independence Health Plan | Medical, Dental | TX | Medicare Advantage |  |
| The Alliance | Medical | WI | Commercial |  |
| The Benefit Group Incorporated | Medical, Dental | NE | Commercial |  |
| The Boon Group | Medical, Dental |  | Commercial |  |
| The City of Odessa | Medical | TX | Commercial |  |
| The Colorado Purchase Alliance | Medical | CO |  |  |
| The Dental Network of Maryland | Dental | MD | Commercial |  |
| The Health Plan of West Virginia | Medical, Dental | WV | Commercial, Medicaid, Medicare Advantage |  |
| The Loomis Company | Medical, Dental |  |  |  |
| The Preferred Healthcare System | Medical |  | Commercial, Medicaid, Medicare Advantage |  |
| The Standard | Dental | Nationwide |  |  |
| The Zero Card | Medical |  | Commercial |  |
| Therapy Network of Puerto Rico | Medical | PR |  |  |
| Thome PACE | Medical | MI | Medicaid, Medicare |  |
| Three Rivers Preferred | Medical | IN | Commercial |  |
| Thrivent | Medical, Vision |  | Medicare |  |
| TML Risk Pool | Medical | TX | Automobile medical, Workers' Compensation |  |
| Total Scholastic Solutions | Medical, Dental |  | Commercial |  |
| TPSC Benefits | Medical |  | Commercial |  |
| TR Paul Inc. | Medical |  |  |  |
| TransactRX | Medical |  |  |  |
| TransactRX Infusion and Specialty | Medical |  |  |  |
| Transamerica Financial Life Insurance Company - Long Term Care | Medical |  | Medicare |  |
| TransAmerica Life Insurance (Little Rock, AR) | Medical |  | Medicare |  |
| TransAmerica Life Insurance Company | Medical, Dental, Vision | Nationwide | Medicare |  |
| Transwestern Insurance Administrators Incorporated | Medical, Dental | CA | Commercial |  |
| Travelers | Medical |  |  |  |
| Travelers Auto | Medical | DE | Automobile medical |  |
| Tres Health | Medical |  | Commercial |  |
| Tribute Health Plans | Medical | AR | Medicaid, Medicare Advantage |  |
| TRICARE West Region | Medical, Dental, Vision | AK, AZ, AR, CA, CO, HI, ID, IL, IN, IA, KS, LA, MN, MO, MT, NE, NV, NM, ND, OK, OR, SD, TX, UT, WA, WI, WY | TRICARE |  |
| Trillium Health Resources | Medical | NC | Commercial |  |
| Trilogy Health Solutions | Medical | WI |  |  |
| Trinity Health Plan | Medical, Dental, Vision | ID, IA, MI, NY, OH | Medicare Advantage |  |
| TRISTAR Benefit Administrators | Medical |  | Commercial |  |
| TRISTAR Insurance Group | Medical, Vision | PA |  |  |
| TRISTAR Insurance Group | Medical, Vision |  | Commercial |  |
| TriState Benefit Solutions (TriHealth Physician Solutions) | Medical |  |  |  |
| Triton Healthcare Partners | Medical |  | Commercial |  |
| Troy Medicare | Medical | NC | Medicaid, Medicare Advantage |  |
| Tru Blue TPA | Medical |  | Commercial |  |
| TrueCare Mississippi Medicaid | Medical | MS | Medicaid |  |
| Truli for Health | Medical, Dental | FL | Commercial |  |
| Trustmark | Medical, Dental, Vision |  |  |  |
| Tucker Administrators | Medical |  | Commercial |  |
| Tufts Health Plan | Medical, Dental, Vision | ME, MA, NH, RI, VT | Commercial, Medicaid, Medicare Advantage |  |
| Tufts Health Plan | Medical, Dental, Vision | MA, RI, NH | Commercial |  |
| U.S. Department of Labor | Medical | Nationwide |  |  |
| U.S. Networks and Administrative Services | Medical, Vision |  |  |  |
| UCare Minnesota | Medical, Dental, Vision | MN | Commercial, Medicaid, Medicare Advantage |  |
| UCLA Health Medicare Advantage Plan | Medical | CA | Medicare Advantage |  |
| UCS Basi Golden Eagle Construction | Medical | CO | Commercial |  |
| UCS Masonry Industry Trust | Medical | OR | Commercial |  |
| UHA Health Insurance | Medical | HI | Commercial |  |
| UHC Dental Government Programs | Dental |  | Commercial, Medicaid, Medicare Advantage |  |
| Ultimate Health Plan | Medical | FL | Medicare |  |
| Umpqua Health | Medical, Dental | OR | Medicaid |  |
| Unified Group Services | Medical, Dental | Nationwide |  |  |
| Unified Health Plan TPA | Medical, Dental |  | Commercial |  |
| Unified Health Services | Medical | Nationwide |  |  |
| Unified Life Insurance | Medical |  | Medicare |  |
| UnifiHealth | Medical, Dental |  |  |  |
| Union Insurance Company of Providence | Medical |  | Workers' Compensation |  |
| Unite Health Share Ministries | Medical |  | Commercial |  |
| Unite Here Health | Medical |  | Commercial |  |
| Unite Here Health Hospitality (UHH Hospitality) | Medical |  | Commercial |  |
| United Agriculture Benefit Trust | Medical | CA | Commercial |  |
| United Benefit Advisors | Medical, Dental |  | Commercial |  |
| United Claim Solutions | Medical |  | Commercial |  |
| United Contract Services (Coeur Leonard Holding Company) | Medical |  | Commercial |  |
| United Food and Commercial Workers Unions and Food Employers Benefit Fund | Medical | CA | Commercial |  |
| United Medical Resources (UMR Onalaska) | Medical, Dental, Vision | WI |  |  |
| United Physicians International (UPI) | Medical | CA | Commercial |  |
| United States Department of Labor - Energy | Medical | Nationwide |  |  |
| Unity Health Partners | Medical |  |  |  |
| Universal Benefits Corporation | Medical |  | Commercial |  |
| Universal Benefits Corporation Cedar Rapids | Medical |  | Commercial |  |
| Universal Health Fellowship | Medical, Dental |  | Commercial |  |
| Universal Healthcare IPA | Medical | CA | Commercial |  |
| University Health Alliance Health Insurance | Medical | HI | Commercial |  |
| University of Illinois at Chicago Division of Specialized Care for Children | Medical, Vision | IL |  |  |
| University of Illinois Chicago CampusCare | Medical | IL | Commercial |  |
| University of Michigan Health Plan | Medical, Dental | MI | Commercial |  |
| University of Texas Medical Branch Correctional Managed Care | Medical | TX |  |  |
| University of Utah Health Plans | Medical, Dental | ID, MT, NV, UT, WY | Commercial, Medicaid, Medicare Advantage |  |
| Unum | Medical, Dental | Nationwide |  |  |
| Upper Peninsula Health Group | Medical | MI | Commercial |  |
| Upper Peninsula Health Plan | Medical, Dental | MI | Medicaid, Medicare Advantage |  |
| Uprise Health | Medical |  | Commercial |  |
| Urogen Support | Medical |  |  |  |
| US Imaging Network | Medical | Nationwide |  |  |
| USAA | Medical |  | Medicare |  |
| USFHP at PacMed | Medical | WA | TRICARE |  |
| USFHP Saint Vincent | Medical | PA |  |  |
| Utica Mutual Insurance Company | Medical | Nationwide |  |  |
| Utica National Insurance Group | Medical | Nationwide | Automobile medical, Workers' Compensation |  |
| UTMB Health Multi-Share Plan | Medical | TX | Commercial |  |
| VA Healthcare | Medical | Nationwide | Veterans Affairs |  |
| Valenz Surgical & Imaging | Medical |  | Commercial |  |
| Valir PACE Organization | Medical | OK | Medicaid, Medicare |  |
| Valley Forge - Iowa | Medical |  |  |  |
| Valley Forge Pennsylvania | Medical | PA |  |  |
| Valley Health Plan | Medical, Dental | CA | Commercial |  |
| Valley Health Plan (Medi-Cal) | Medical | CA | Medicaid |  |
| Valley Presbyterian Hospital | Medical | CA |  |  |
| Valley Presbyterian Hospital Preferred IPA | Medical |  | Commercial |  |
| Valor Health Plan | Medical | OH | Medicare Advantage |  |
| Van Lang IPA | Medical, Dental |  | Commercial |  |
| Varipro | Medical | Nationwide |  |  |
| Vault Strategies | Medical |  | Commercial |  |
| Ventura County Health Care Plan | Medical | CA | Commercial |  |
| Verda (TPHN) | Medical |  | Commercial |  |
| Verda Health Plan of Arizona | Medical | AZ | Medicare Advantage |  |
| Verda Health Plan of Texas | Medical | TX | Medicare Advantage |  |
| Verdegard Employee Plan | Medical |  | Commercial |  |
| Verity Plus | Medical | OR | Commercial |  |
| VestaCare | Medical |  |  |  |
| Veterans Affairs Community Care Network (TriWest Healthcare Alliance Region 6) | Medical |  |  |  |
| Veterans Affairs Fee Basis Program | Medical, Dental | Nationwide | Veterans Affairs |  |
| Veterans Affairs Financial Services Center | Medical | Nationwide |  |  |
| ViCare Health | Medical |  |  |  |
| VieCare Life Armstrong | Medical | PA | Medicaid, Medicare |  |
| VieCare Life Beaver and Life Lawrence Counties | Medical | PA | Medicaid, Medicare Advantage |  |
| Viecare Life Butler | Medical | PA | Medicaid, Medicare |  |
| Village Medical | Medical |  | Commercial |  |
| VillageCareMAX | Medical, Dental | NY | Medicaid, Medicare Advantage |  |
| Virginia Health Network Inc | Medical | VA |  |  |
| Virginia Surety Company Incorporated | Medical |  | Workers' Compensation |  |
| Vitori Health | Medical |  | Commercial |  |
| Vitruvian Care Incorporated | Medical |  |  |  |
| Viva Health | Medical, Dental, Vision | AL | Commercial, Medicare Advantage |  |
| Vivant Health | Medical |  |  |  |
| Vivity | Medical, Dental, Vision | CA | Commercial |  |
| VNS Health | Medical, Dental | NY | Medicaid, Medicare Advantage |  |
| VSP Vision Service Plan | Medical, Vision |  |  |  |
| Vxtra Health Plan Inc. | Medical, Dental |  |  |  |
| Vytalize Health | Medical |  | Commercial |  |
| Walmart | Medical |  | Workers' Compensation |  |
| Washington County General Fund | Medical | OR |  |  |
| Washington County Health and Human Services | Medical | OR |  |  |
| Washington State Department of Labor and Industries | Medical | WA |  |  |
| Washington State Department of Labor and Industry | Medical | WA |  |  |
| WelbeHealth | Medical, Dental | CA | Medicaid, Medicare |  |
| Wellabe Medicare Supplement | Medical, Dental | DC | Medicare |  |
| Wellfleet | Medical |  | Commercial |  |
| WellMed | Medical, Dental, Vision | FL, TX |  |  |
| WellMed (Encounters) | Medical | FL, TX |  |  |
| WellNet | Medical, Dental |  | Commercial |  |
| WellPoint Medicare Supplement | Medical, Dental, Vision |  | Medicare |  |
| WellSense Health Plan | Medical, Dental, Vision | MA, NH | Medicaid, Medicare Advantage |  |
| WellSpace Nexus LLC | Medical |  |  |  |
| WellStar Health Plan | Medical, Dental | GA | Commercial |  |
| West PACE | Medical | CA | Medicaid, Medicare |  |
| West Virginia Medicaid  | Medical, Dental | WV | Medicaid |  |
| West Virginia Public Employees Insurance Agency | Dental | WV | Commercial |  |
| West Virginia Senior Advantage | Medical | WV | Medicare Advantage |  |
| Western Health Advantage | Medical, Dental, Vision | CA | Commercial |  |
| Western Pennsylvania Electrical Employees Insurance Trust Fund | Medical, Dental | PA | Commercial |  |
| WEX Health INC | Medical |  |  |  |
| William C. Earhart Company | Medical |  | Commercial |  |
| Wilson-McShane Corporation | Medical, Dental | MN | Commercial |  |
| Wisconsin Auto Truck Dealer Association (WATDA) | Dental | WI | Commercial |  |
| Wisconsin Chronic Disease Program | Medical | WI | Medicaid |  |
| Wisconsin Preferred Provider Network (Claritev) | Medical | Nationwide |  |  |
| Wisconsin Well Woman Program | Medical | WI |  |  |
| WMI TPA | Medical | AZ, ID, MT, NV, UT | Commercial |  |
| Women's Integrated Network Incorporated (WIN Fertility) | Medical |  |  |  |
| Workforce Safety and Insurance (WSI) | Medical | ND | Workers' Compensation |  |
| World Trade Center Health Program | Medical | Nationwide |  |  |
| Worldwide Medical Assurance Ltd Corp | Medical |  |  |  |
| Writers Guild Industry Health | Medical |  | Commercial |  |
| WTC Health Program | Medical | Nationwide |  |  |
| XO Health | Medical |  |  |  |
| Yale Health | Medical | CT | Commercial |  |
| Yamhill CCO | Medical, Dental | OR | Medicaid |  |
| Yamhill CCO Physical Health | Medical | OR | Medicaid |  |
| YesCare | Medical |  |  |  |
| Yuzu Health | Medical, Dental | AZ, AR, CA, DE, IA, ID, IN, KS, KY, LA, MN, MS, MT, NC, ND, NE, NJ, NM, OH, OK, PA, SC, TN, TX, UT, VT, WA, WI | Commercial |  |
| Zenith American Solutions | Dental |  | Commercial |  |
| Zurich American Insurance Company | Medical |  |  |  |
| Zurich Insurance North America | Medical |  |  |  |

## Portals

The portal each payer uses to change its bank account, most payers first.

| Portal | Payers | Link |
| --- | --- | --- |
| ECHO Health | 120 | [Open portal](https://enrollments.echohealthinc.com) |
| PECOS | 111 | [Open portal](https://pecos.cms.hhs.gov) |
| Zelis Payments | 63 | [Open portal](https://provider.zelispayments.com/Registration) |
| Availity Essentials | 43 | [Open portal](https://essentials.availity.com) |
| Delta Dental Provider Tools | 42 | [Open portal](https://www.deltadentalins.com) |
| EnrollSafe / PayeeHub | 34 | [Open portal](https://enrollsafe.payeehub.org) |
| InstaMed | 18 | [Open portal](https://www.instamed.com) |
| PaySpan Health | 18 | [Open portal](https://payspanhealth.com) |
| Optum Health Payment Services | 15 | [Open portal](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do) |
| Optum Pay | 13 | [Open portal](https://myservices.optumhealthpaymentservices.com) |
| Payer Enrollment Services | 7 | [Open portal](https://payerenrollservices.com/) |
| Change Healthcare ProviderNet | 4 | [Open portal](https://providernet.adminisource.com) |
| EmblemHealth EFT with PNC and ECHO | 4 | [Open portal](https://www.emblemhealth.com/providers/news/sign-up-for-eft-with-pnc-echo-202508) |
| First Choice EFT enrollment | 4 | [Open portal](https://www.selecthealthofsc.com/provider/claims-billing/eft) |
| Keystone First EFT guide | 4 | [Open portal](https://apps.keystonefirstpa.com/pdf/provider/claims-billing/eft/eft-quick-guide.pdf) |
| Cigna for Health Care Professionals | 3 | [Open portal](https://cignaforhcp.cigna.com/app/login) |
| DentaQuest Provider Portal | 3 | [Open portal](https://providers.dentaquest.com/onboarding/start/) |
| EnrollSafe | 3 | [Open portal](https://enrollsafe.payeehub.org) |
| Mercy Care EFT guide | 3 | [Open portal](https://www.mercycareaz.org/content/dam/mercycare/pdf/EFT%20GR-69611%20%206-21.pdf) |
| TMHP PEMS | 3 | [Open portal](https://www.tmhp.com/topics/provider-enrollment/pems/itp-eft) |
| Zelis provider enrollment | 3 | [Open portal](https://www.zelis.com/providers/provider-enrollment) |
| Ameritas ePayment Center | 2 | [Open portal](https://ameritas.epayment.center/Registration) |
| Availity | 2 | [Open portal](https://apps.availity.com) |
| Optum Payments Connector | 2 | [Open portal](https://portal.paymentsconnector.optum.com/) |
| Alabama Medicaid Provider Portal | 1 | [Open portal](https://www.medicaid.alabamaservices.org/alportal/) |
| Arkansas MMIS Provider Portal | 1 | [Open portal](https://portal.mmis.arkansas.gov) |
| AZ Blue Provider Portal | 1 | [Open portal](https://www.azblue.com/provider/electronic-options) |
| BCBS Alabama EFT Enrollment Hub | 1 | [Open portal](https://bcbsal.payeehub.org/) |
| Blue Cross NC EFT payments | 1 | [Open portal](https://www.bluecrossnc.com/providers/network-participation/eft-payments) |
| Blue Cross of Idaho Provider Portal | 1 | [Open portal](https://providers.bcidaho.com/policies-and-procedures/pap/pap259.page) |
| Blue Shield of California Provider Portal | 1 | [Open portal](https://www.blueshieldca.com/en/provider) |
| Colorado Medicaid EFT update | 1 | [Open portal](https://hcpf.colorado.gov/update-eft) |
| ConnectiCare EFT sign-up | 1 | [Open portal](https://www.connecticare.com/providers/resources/news/get-your-claims-payments-sent-directly-to-your-bank-accounts) |
| Connecticut Medicaid Secure Web Portal | 1 | [Open portal](https://www.ctdssmap.com) |
| ECHO Guardian enrollment | 1 | [Open portal](https://enrollments.echohealthinc.com/EFTERADirect/Guardian) |
| EMI Health provider EFT form | 1 | [Open portal](https://emihealth.com/Forms/ProviderEFT) |
| Empower ePayment Center | 1 | [Open portal](https://empowerhealthcaresolutions.epayment.center/Registration) |
| Fidelis Care EFT form | 1 | [Open portal](https://www.fideliscare.org/Apps/eft/) |
| Georgia GAMMIS Portal | 1 | [Open portal](https://www.mmis.georgia.gov) |
| HAP Provider Portal | 1 | [Open portal](https://www.hap.org/providers) |
| Humana Military Provider Portal | 1 | [Open portal](https://www.humanamilitary.com/provider) |
| Kentucky Medicaid Partner Portal | 1 | [Open portal](https://medicaidsystems.ky.gov/Partnerportal/home.aspx) |
| Medi-Cal PAVE Portal | 1 | [Open portal](https://pave.dhcs.ca.gov) |
| Medica Partner Portal | 1 | [Open portal](https://partner.medica.com) |
| MetLife Dental ePayment Center | 1 | [Open portal](https://metlifedental.epayment.center) |
| New Mexico Medicaid Portal | 1 | [Open portal](https://nmmedicaid.portal.conduent.com/) |
| Ohio Medicaid PNM Portal | 1 | [Open portal](https://ohpnm.omes.maximus.com/OH_PNM_PROD/Resources.aspx) |
| ProviderOne instructions | 1 | [Open portal](https://www.hca.wa.gov/assets/billers-and-providers/updating-payment-details-instructions.pdf) |
| Select Health payments | 1 | [Open portal](https://selecthealth.org/providers/claims/payments) |
| UHC Dental ePayment Center | 1 | [Open portal](https://uhcdental.epayment.center/registration) |
| UMWA electronic claims payment | 1 | [Open portal](https://www.umwafunds.org/billing-claims/electronic-claims-payment/) |
| UPMC Provider Online | 1 | [Open portal](https://www.upmchealthplan.com/providers/) |
| Utah Medicaid payment details | 1 | [Open portal](https://medicaid.utah.gov/document/update-payment-details-4-minutes-4/) |
| VA FSC Customer Engagement Portal | 1 | [Open portal](https://www.cep.fsc.va.gov) |
| Wellmark EFT form | 1 | [Open portal](https://digital-assets.wellmark.com/adobe/assets/urn:aaid:aem:2de4b5e9-3dd6-43f4-8dae-adb3e4d978bc/original/as/EFT_FAQ.pdf) |
| Zelis ePayment Center | 1 | [Open portal](https://www.zelis.com) |

## Instructions

These payers publish a portal walkthrough. The table above lists payers with a walkthrough first, then payers with a bank change method but no walkthrough, then every other payer, each group alphabetical.

### AARP UnitedHealthCare Insurance Company

**AARP Supplemental from UnitedHealthcare**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "AARP Supplemental from UnitedHealthcare" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### Aetna

**Aetna**

Portal: [Payer Enrollment Services](https://payerenrollservices.com/)

1. Go to https://payerenrollservices.com/ and log in with your provider credentials.
2. Click the "PAYER LIST" tab at the top of the page.
3. Locate "Aetna" in the Payer List.
4. Click on the payer to view or update your enrollment details.

### Aetna Better Health

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health - Nevada

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health California

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Florida

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Kansas

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Kentucky

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Louisiana

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Maryland

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Michigan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health New Jersey

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health New York

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health of Illinois

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health of West Virginia

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Ohio

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Oklahoma

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Pennsylvania

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Texas

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Better Health Virginia

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Dental Medicare

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Optum Pay: https://myservices.optumhealthpaymentservices.com ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna Medicaid Illinois

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Aetna OhioRISE Medicaid Managed Care Entity

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Aetna Better Health pays through ECHO Health. The state EFT and ERA forms have a Change reason and ask for a voided check or bank letter. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AFLAC

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Alignment Health Plan

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Allegiance Benefit Plan Management Incorporated

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Alterwood Advantage

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Altrua Healthshare

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Amerigroup

**Amerigroup (NM)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Amerigroup (NM)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Amerigroup RealSolutions in Healthcare (GA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Amerigroup RealSolutions in Healthcare (GA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### AmeriHealth

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth - Delaware (Non HMO)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Delaware

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas District of Columbia

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Florida

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Louisiana

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas New Hampshire

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Next (Delaware)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Next (Florida)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Next (Louisiana)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Next (North Carolina)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas North Carolina

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Northeast

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Ohio

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Ohio (Transportation Only) 

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Pennsylvania

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas Pennsylvania Dental

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care - Michigan HIDE SNP

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care – Delaware

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care – Florida

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care – Louisiana

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care – North Carolina

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care – Pennsylvania

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care Delaware Dual Special Needs Plan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth Caritas VIP Care Plus

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Enroll in EFT through ECHO Health. Enrolling in EFT also provides ERAs at no fee. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### AmeriHealth NJ

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Anthem Blue Cross and Blue Shield Nevada

**Anthem Blue Cross and Blue Shield (NV)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (NV)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross and Blue Shield Nevada - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross and Blue Shield New Hampshire

**Anthem Blue Cross and Blue Shield (NH)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (NH)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross and Blue Shield New Hampshire - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross and Blue Shield Virginia

**Anthem Blue Cross and Blue Shield (VA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (VA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Anthem Blue Cross and Blue Shield HealthKeepers (VA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield HealthKeepers (VA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Anthem HealthKeepers (VA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem HealthKeepers (VA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross and Blue Shield Virginia - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross and Blue Shield Wisconsin

**Anthem Blue Cross and Blue Shield (WI)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (WI)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross and Blue Shield Wisconsin - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield Missouri

**Anthem Blue Cross and Blue Shield (MO)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (MO)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield Missouri - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield of California

**Anthem Blue Cross (CA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross (CA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Anthem Blue Cross Life and Health Insurance Company (CA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross Life and Health Insurance Company (CA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield of Colorado

**Anthem Blue Cross and Blue Shield (CO)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (CO)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield of Colorado - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield of Connecticut

**Anthem Blue Cross and Blue Shield (CT)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (CT)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield of Connecticut - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield of Connecticut Federal Employees Program

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield of Georgia

**Anthem Blue Cross and Blue Shield (GA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (GA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield of Indiana

**Anthem Blue Cross and Blue Shield (IN)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (IN)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield of Indiana - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield of Maine

**Anthem Blue Cross and Blue Shield (ME)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (ME)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield of Maine - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross Blue Shield of New York

**Anthem Blue Cross (NY)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross (NY)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Anthem Blue Cross and Blue Shield (NY)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (NY)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield Ohio

**Anthem Blue Cross and Blue Shield (OH)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (OH)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem Blue Cross Blue Shield Ohio - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Blue Cross of New York Dental

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

**Or: Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

**Or: EnrollSafe: cancel and re-enroll**

Portal: [EnrollSafe](https://enrollsafe.payeehub.org)

EnrollSafe cannot change a bank account in place, and an enrollment replaces all historical EFT enrollments for the entire TIN. Enumerate every TIN and NPI combination before submitting, because any left out drops to virtual card or check with third party fees. Checks may resume during the gap.

Have the practice Tax ID, the payer-issued provider ID, the new bank details and a voided check or bank letter (a front-only check image is not enough).

1. Log in to EnrollSafe, which is a different login from Availity.
2. Enter the TIN and the payer-issued provider ID, set the primary user preference, then Continue.
3. If an enrollment is active, open it, choose Actions, then Cancel. Wait until "cancel enrollment request is pending" clears.
4. Click Add bank account, then select Checking and Business.
5. Enter the account holder legal name, financial institution name, routing number and account number (twice).
6. Select File and attach the proof of account, then click Add Bank Account.
7. Link the bank to the enrollment, then Continue.
8. Submit the enrollment, tick Agree and type your name as the electronic signature.

### Anthem BlueCross BlueShield Kentucky

**Anthem Blue Cross and Blue Shield (KY)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield (KY)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Anthem Blue Cross and Blue Shield Medicaid (KY)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield Medicaid (KY)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Anthem BlueCross BlueShield Kentucky - Dental

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem Maine Health

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Anthem MaineHealth

**Anthem Blue Cross and Blue Shield MaineHealth**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Anthem Blue Cross and Blue Shield MaineHealth" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### ArcBest Corporation

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Arkansas Blue Cross and Blue Shield

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### ASA GEHA

**Government Employees Health Association**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "Government Employees Health Association" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### Atrio Health Plans

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Banner Medicare Advantage Dual HMO D-SNP

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Banner Medicare Advantage Prime HMO 

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Blue Cross and Blue Shield of Illinois

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross and Blue Shield of Kansas

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross and Blue Shield of Minnesota

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Allow up to 90 days. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross and Blue Shield of Montana

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross and Blue Shield of Nebraska

**EnrollSafe: cancel and re-enroll**

Portal: [EnrollSafe](https://enrollsafe.payeehub.org)

Cancel and re-add. EnrollSafe cannot change a bank account in place, and an enrollment replaces all historical EFT enrollments for the entire TIN. Enumerate every TIN and NPI combination before submitting, because any left out drops to virtual card or check with third party fees. Checks may resume during the gap.

Have the practice Tax ID, the payer-issued provider ID, the new bank details and a voided check or bank letter (a front-only check image is not enough).

1. Log in to EnrollSafe, which is a different login from Availity.
2. Enter the TIN and the payer-issued provider ID, set the primary user preference, then Continue.
3. If an enrollment is active, open it, choose Actions, then Cancel. Wait until "cancel enrollment request is pending" clears.
4. Click Add bank account, then select Checking and Business.
5. Enter the account holder legal name, financial institution name, routing number and account number (twice).
6. Select File and attach the proof of account, then click Add Bank Account.
7. Link the bank to the enrollment, then Continue.
8. Submit the enrollment, tick Agree and type your name as the electronic signature.

### Blue Cross and Blue Shield of New Mexico

**Blue Cross and Blue Shield of New Mexico**

Portal: [Availity Essentials](https://essentials.availity.com)

BCBS New Mexico has no ERA/EFT app in Payer Spaces, so use Transaction Enrollment. Each Blue plan is a separate payer: submit and check each one on its own.

Have ready an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the bank name, routing number, account number and account type, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross and Blue Shield of Texas

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Blue Shield FEP BlueDental

**Blue Cross Blue Shield FEP Dental**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Blue Cross Blue Shield FEP Dental" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Blue Cross Blue Shield of Massachusetts

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Blue Cross Blue Shield of Michigan

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Allow up to 2 weeks. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Blue Shield of North Dakota

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Allow up to 60 days. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Blue Shield of Wyoming

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Cancel and re-add. Allow up to 30 days. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Blue Shield Oklahoma

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Blue Shield Texas Medicaid STAR CHIP

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Listed in Transaction Enrollment. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Community Health Plans

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Blue Cross Complete of Michigan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

EFT is set up through ECHO Health, and payments go to the account you designate. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/efteradirect/enroll)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### BlueCross BlueShield of Tennessee

**BlueCross BlueShield of Tennessee**

Portal: [Payer Enrollment Services](https://payerenrollservices.com/)

1. Go to https://payerenrollservices.com/ and log in with your provider credentials.
2. Click the "PAYER LIST" tab at the top of the page.
3. Locate "BlueCross BlueShield of Tennessee" in the Payer List.
4. Click on the payer to view or update your enrollment details.

### Braven Health

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Buckeye Health Plan

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Capital Blue Cross of Pennsylvania

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Capital Health Plan

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### CareFirst Administrators

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

**Or: Change Healthcare ProviderNet**

Portal: [Change Healthcare ProviderNet](https://providernet.adminisource.com)

[Change Healthcare ProviderNet](https://providernet.adminisource.com): Enroll or update EFT in Change Healthcare ProviderNet.

**Or: Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### CareFirst Blue Cross Blue Shield Maryland

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

CareFirst also pays through Zelis. Seen paying through the Zelis CareFirst portal. Paper checks arrive if portal access is lost. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### CareFirst BlueCross BlueShield Medicare Advantage

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Carelon Behavioral Health

**EnrollSafe: cancel and re-enroll**

Portal: [EnrollSafe](https://enrollsafe.payeehub.org)

EnrollSafe cannot change a bank account in place, and an enrollment replaces all historical EFT enrollments for the entire TIN. Enumerate every TIN and NPI combination before submitting, because any left out drops to virtual card or check with third party fees. Checks may resume during the gap.

Have the practice Tax ID, the payer-issued provider ID, the new bank details and a voided check or bank letter (a front-only check image is not enough).

1. Log in to EnrollSafe, which is a different login from Availity.
2. Enter the TIN and the payer-issued provider ID, set the primary user preference, then Continue.
3. If an enrollment is active, open it, choose Actions, then Cancel. Wait until "cancel enrollment request is pending" clears.
4. Click Add bank account, then select Checking and Business.
5. Enter the account holder legal name, financial institution name, routing number and account number (twice).
6. Select File and attach the proof of account, then click Add Bank Account.
7. Link the bank to the enrollment, then Continue.
8. Submit the enrollment, tick Agree and type your name as the electronic signature.

### CareOregon

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### CarePartners of Connecticut

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### CarePlus

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

in Payer Spaces. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### CareSource (Common Ground Healthcare Cooperative )

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Georgia (Marketplace)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Indiana

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Kentucky

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Caresource Military and Veterans

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Nevada Marketplace

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Nevada Medicaid

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource of Michigan Medicaid

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Ohio Marketplace

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource Ohio Medicaid

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CareSource PASSE

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### CDPHP

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Also enroll or update through EnrollSafe / PayeeHub: https://enrollsafe.payeehub.org The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Centene (Behavioral Health)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Centene (Medical)

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Central California Alliance for Health

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Change Healthcare ProviderNet: https://providernet.adminisource.com ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Chorus Community Health Plans

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Zelis Payments: https://provider.zelispayments.com/Registration ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Cigna

**Cigna**

Portal: [Cigna for Health Care Professionals](https://cignaforhcp.cigna.com/app/login)

1. Go to https://cignaforhcp.cigna.com/app/login and log in with your provider credentials.
2. Navigate to the relevant section to update your payer portal settings.

### Clear Health Alliance

**Clear Health Alliance**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Clear Health Alliance" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Colorado Community Health Alliance

**Colorado Community Health Alliance**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Colorado Community Health Alliance" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Community First Health Plans

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Cook Children's Health Plan (CHIP)

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Cook Children's Health Plan (STAR)

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### CountyCare

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Also enroll or update through InstaMed: https://www.instamed.com Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Delta Dental - DDIC

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental (Individual Plans)

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental Arizona

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental Arkansas

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental Colorado

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental Illinois

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental Indiana

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental Michigan

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental New Mexico

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental New York

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental North Carolina

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Alaska

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of California

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Delaware

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of District of Columbia (D.C.)

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Idaho

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Iowa

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Iowa - Dental Wellness Plan (DWP)

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Kansas

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Kentucky

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Maryland

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Massachusetts

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Minnesota

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Missouri

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Nebraska

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of New Jersey

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Northeast

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Ohio

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Oklahoma

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Oregon

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Pennsylvania

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Puerto Rico

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Rhode Island

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of South Carolina

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of South Dakota

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of South Dakota (Medicare Advantage)

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Tennessee

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Virginia

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Washington

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of West Virginia

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Wisconsin

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Delta Dental of Wyoming

**Delta Dental Provider Tools: change EFT**

Portal: [Delta Dental Provider Tools](https://www.deltadentalins.com)

Dentegra and the FEDVIP and VADIP federal programs also appear under Delta Dental descriptors. Use the national deltadentalins.com portal, not a state-specific Delta Dental site. Change EFT only, not ERA. Takes 7 to 14 business days with no micro-deposit. Paper checks can appear during the switch.

Have the new account and routing numbers and a voided check as a file.

1. Log in at https://www.deltadentalins.com/ciam/login.
2. Open the EFT enrollment area and choose to change the EFT enrollment information. You will be asked to log in again.
3. Enter the account number and the routing number, then re-enter the account number.
4. Upload the voided check.
5. Submit.

### Denver Health Medical Plan Incorporated (Medicare Choice)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Devoted Health

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

Moved from PaySpan to Zelis in August 2026. Update it in Zelis. The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### DHMN Santa Cruz

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Direct Care Administrators

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Change Healthcare ProviderNet: https://providernet.adminisource.com ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Driscoll Health Plan

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Listed in Transaction Enrollment. No additional paperwork is required. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Essence Healthcare

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Fallon Health

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### First Choice Health

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Florida Blue

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Geisinger Health Plan

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Also enroll or update through InstaMed: https://www.instamed.com Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### GlobalHealth

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Gold Kidney Health Plan

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Golden Rule

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Great Bay Administrators

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Harmony Health Plan

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Harvard Pilgrim Health Care

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Health Alliance Plan (Michigan)

**HAP (Health Alliance Plan)**

Portal: [HAP Provider Portal](https://www.hap.org/providers)

Allow up to 4 weeks for enrollment. HAP sends a 1-cent test deposit to verify your account before live payments begin. Questions? Contact accountspayable@hap.org.

1. Go to https://www.hap.org/providers for general provider information.
2. Download the HAP Direct Deposit (EFT) Application from the HAP provider site.
3. Fill in: Provider/Vendor Tax ID (TIN/EIN), Provider Name, Address, EFT Contact Name, Phone, and Email.
4. Fill in your bank details: Financial Institution Name, City/State, 9-digit Routing Number, and Account Number.
5. Select enrollment type: New Enrollment, Change Enrollment, or Cancel Enrollment.
6. Have an authorized signer sign and date the completed form.
7. Attach a voided check (or bank letter on letterhead) to the PDF.
8. Email the completed form + voided check to accountspayable@hap.org.

### Health First

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Health Net Claims (California Oregon)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Health Plan of Nevada

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Health Valley Provider Network

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### HealthChoice of Oklahoma

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Healthfirst

**Healthfirst NY**

Portal: [Payer Enrollment Services](https://payerenrollservices.com/)

1. Go to https://payerenrollservices.com/ and log in with your provider credentials.
2. Click the "PAYER LIST" tab at the top of the page.
3. Locate "Healthfirst NY" in the Payer List.
4. Click on the payer to view or update your enrollment details.

### HealthSmart Benefit Solutions

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### HealthSun Health Plans

**HealthSun Health Plans**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "HealthSun Health Plans" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### HealthTeam Advantage

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Healthy Blue Kansas

**Healthy Blue Kansas (KS)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Healthy Blue Kansas (KS)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Healthy Blue Louisiana

**Blue Cross Blue Shield Healthy Blue (LA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Blue Cross Blue Shield Healthy Blue (LA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Healthy Blue Missouri

**Blue Cross Blue Shield Healthy Blue (MO)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Blue Cross Blue Shield Healthy Blue (MO)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Healthy Blue Nebraska

**Blue Cross Blue Shield Healthy Blue Heritage Health (NE)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Blue Cross Blue Shield Healthy Blue Heritage Health (NE)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Healthy Blue North Carolina

**Blue Cross Blue Shield of North Carolina Healthy Blue**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Blue Cross Blue Shield of North Carolina Healthy Blue" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Healthy Blue + Medicare (NC)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Healthy Blue + Medicare (NC)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Healthy Blue South Carolina

**Healthy Blue - Blue Choice HealthPlan of SC - Healthy Connections**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Healthy Blue - Blue Choice HealthPlan of SC - Healthy Connections" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Highmark Blue Cross Blue Shield (NY) - Medicaid and CHP

**HIGHMARK WNY BCBS MEDICAID CHP**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "HIGHMARK WNY BCBS MEDICAID CHP" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Highmark Blue Cross Blue Shield (Western and Northeastern NY)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Blue Cross Blue Shield of Delaware

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Blue Cross Blue Shield of West Virginia

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Blue Cross Blue Shield of Western New York

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Pennsylvania Central Region

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Pennsylvania Southeastern Region

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Pennsylvania Western Region

**Highmark Pennsylvania Western Region**

Portal: [Availity](https://apps.availity.com)

1. Go to https://apps.availity.com and log in with your Availity provider credentials.

### Highmark Senior Health Company

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Senior Solutions

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Highmark Wholecare Medicare Assured

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Horizon Blue Cross and Blue Shield of New Jersey

**Horizon BCBS NJ Dental Programs**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Horizon BCBS NJ Dental Programs" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Humana

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

in Payer Spaces. Humana EFT is not offered in Transaction Enrollment. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### Humana (KV) - JVHL

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### Humana Dental

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### Humana Health Plan Ohio

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

in Payer Spaces. Humana EFT is not offered in Transaction Enrollment. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### Humana Healthy Horizons in Ohio

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### Independence Administrators

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through InstaMed: https://www.instamed.com ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Independence Blue Cross

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Innovation Health

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### IntegraNet Health

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Jefferson Health Plans

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Johns Hopkins Advantage MD

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/EFTERADirect/JohnsHopkins/)

Enroll in EFT through ECHO Health with your TIN and bank account information. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/EFTERADirect/JohnsHopkins/)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Johns Hopkins Health Plans

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/EFTERADirect/JohnsHopkins/)

Enroll in EFT through ECHO Health with your TIN and bank account information. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/EFTERADirect/JohnsHopkins/)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Johns Hopkins U.S. Family Health Plan (USFHP)

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/EFTERADirect/JohnsHopkins/)

Enroll in EFT through ECHO Health with your TIN and bank account information. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com/EFTERADirect/JohnsHopkins/)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### KeyCare Advantage

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Keystone Health Plan East

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### L.A. Care Health Plan (California)

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### LACH HealthNet by MedPoint

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Liberty Dental Plan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### LifeWise Assurance Company

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### LifeWorks Advantage

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Marketplace (ACA) plans

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

The carrier is often masked on the deposit. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Maryland Medicare Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Mass General Brigham Health Plan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Medica Government Programs

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

**Or: Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

**Or: InstaMed**

Portal: [InstaMed](https://www.instamed.com)

[InstaMed](https://www.instamed.com): Enroll or update EFT in InstaMed.

### Medica Individual and Family

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

**Or: Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

**Or: InstaMed**

Portal: [InstaMed](https://www.instamed.com)

[InstaMed](https://www.instamed.com): Enroll or update EFT in InstaMed.

### Medicare Alabama Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Alabama Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Alaska Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Alaska Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare American Samoa Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare American Samoa Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Arizona Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Arizona Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Arkansas Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Arkansas Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare California Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Colorado Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Colorado Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Connecticut Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Connecticut Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Delaware Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Delaware Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare District of Columbia Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare District of Columbia Part A (J12 Highmark)

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare District of Columbia Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Florida Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Florida Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Georgia Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Georgia Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Home Health and Hospice J15

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Idaho Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Idaho Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Illinois Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Illinois Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Indiana Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Indiana Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Iowa Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Iowa Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Kansas Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Kansas Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Kentucky Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Kentucky Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Louisiana Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Louisiana Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Maine Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Maine Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Maryland Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Massachusetts Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Massachusetts Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Michigan Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Michigan Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Minnesota Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Minnesota Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Mississippi Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Mississippi Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Missouri Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Missouri Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Montana Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Montana Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Nebraska Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Nebraska Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Nevada Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Nevada Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New Hampshire Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New Hampshire Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New Jersey Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New Jersey Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New Mexico Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New Mexico Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New York Downstate

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New York Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New York Part B Queens

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare New York Part B Upstate

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare North Carolina Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare North Carolina Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare North Dakota Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare North Dakota Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Northern California Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Northern California Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Ohio Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Ohio Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Oklahoma Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Oklahoma Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Oregon Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Oregon Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Pennsylvania Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Pennsylvania Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Puerto Rico Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Puerto Rico Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Rhode Island Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Rhode Island Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare South Carolina Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare South Carolina Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare South Dakota Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare South Dakota Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Southern California Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Tennessee Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Tennessee Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Texas Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Texas Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Utah Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Utah Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Vermont Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Vermont Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Virgin Islands Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Virgin Islands Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Virginia Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Virginia Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Washington Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare West Virginia Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare West Virginia Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Wisconsin Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Wisconsin Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Wyoming Part A

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### Medicare Wyoming Part B

**Medicare EFT change in PECOS**

Portal: [PECOS](https://pecos.cms.hhs.gov)

Medicare has no standalone bank change. It is filed as a change of information on the whole enrollment, so PECOS revalidates the record and unrelated errors can appear. Allow 60 to 90 days and keep the old account live until Medicare confirms. Only an authorized or delegated official can sign.

Have an I&A login, the bank letter or voided check as a PDF in the legal business name, a signer who is free for the next 72 hours, and a contact who will answer the contractor verification call.

1. Sign in to I&A at nppes.cms.hhs.gov/IAWeb and open PECOS from Application Links.
2. Open My Associates, scroll to Organizations, and choose View Enrollments for the practice.
3. On the group enrollment, choose More Options, then Perform a change of information to current enrollment information.
4. Choose to make other changes, then Start application.
5. Upload the bank letter or voided check under Required and/or Supporting Documentation, with delivery set to Upload.
6. Open Electronic Funds Transfer, delete the existing bank record with a termination date, then add the new bank record.
7. Run error check and clear every error. Warnings do not block submission.
8. Begin Submission, choose Electronic signature, and have the authorized or delegated official sign.
9. Complete Submission, print the receipt and record the Web Tracking ID.
10. Expect a verification call from the contractor. Medicare keeps paying the old account until the change is processed.

### MedStar Family Choice District of Columbia

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Sign up for EFT through ECHO Health at the TIN level, by mail or in the ECHO portal. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### MedStar Family Choice Maryland

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Sign up for EFT through ECHO Health at the TIN level, by mail or in the ECHO portal. ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### MercyCare

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Meridian (Illinois)

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Meridian (Michigan)

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Meritain Health

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Complete Care Virginia DSNP

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare - Affinity by Molina Healthcare

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare - New Mexico Medicaid

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare California

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Florida

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina HealthCare Idaho

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Illinois

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Michigan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Nebraska

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina HealthCare Nevada

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare New Mexico

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare of Iowa

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare of Mississippi

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina HealthCare Ohio

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Texas

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Utah

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina HealthCare Washington

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Healthcare Wisconsin

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Molina Ohio Medicaid Managed Care Entity

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Mutual of Omaha

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Network Administrators

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Network Health Commercial

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Zelis Payments: https://provider.zelispayments.com/Registration ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Network Health Medicare

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Zelis Payments: https://provider.zelispayments.com/Registration ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Network Health TPA

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Also enroll or update through Zelis Payments: https://provider.zelispayments.com/Registration ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### NeueHealth

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Next Generation MyCare Ohio - Buckeye

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### NHC Advantage

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Optum Beaver Medical Group

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Optum California

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Optum Salt Lake County

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Optum San Bernardino Medical Group

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### OSU Humana Healthy Horizons

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

### Oxford

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### PacificSource

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### PacificSource Administrators

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### PacificSource Medicare

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Parkland Community Health Plan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Passport Health Plan by Molina Healthcare

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Register with Availity Essentials to enroll in and manage EFT and ERA. Verify your routing and account numbers, because errors delay setup. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Peach State Health Plan

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Perennial Advantage of Ohio

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### PHP Medical

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Planstin

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Preferred Provider Organization Plus LLC

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Premera Blue Cross Alaska

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Cancel and re-add for a new account. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Premera Blue Cross of Washington

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Cancel and re-add for a new account. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Presbyterian Health Plan (Commercial)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Presbyterian Health Plan Medicaid

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Presbyterian Medicare

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Prominence Health Plan (Commercial)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Prominence Medicare Advantage (Florida)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Prominence Medicare Advantage (Nevada)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Prominence Medicare Advantage (Texas)

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Providence Health Plan

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Quest Behavioral Health

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Regence BlueCross BlueShield of Oregon

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Regence BlueCross BlueShield of Utah

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Regence BlueShield of Idaho

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Regence BlueShield of Washington

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Salia Healthcare

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Sana Benefits

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Sanford Health Plan

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Sanford Health Plan Medicare Advantage

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Santa Clara County

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### SCAN Health Plan

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Senior Whole Health

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Senior Whole Health of New York

**ECHO Health portal: Update Bank Account**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

ECHO asks for the old bank in full: name, routing number, account number and branch address. This form only changes an existing ECHO EFT/ERA enrollment.

Have the old bank details, the new bank details and the practice Tax ID to hand. The login code is sent by SMS and expires in about 90 seconds, so have the code holder on the phone.

1. Log in at providerpayments.com.
2. Click Provider Resources, then Update Bank Account, then Add a New Request.
3. In Name, enter the bank or requestor name and the billing street, city, state and ZIP.
4. In the Current bank account block, enter the old bank name, routing number, account number and branch address.
5. In the New bank account block, enter the new bank name, address, routing number, account number and account type.
6. Leave "Account closed" blank unless the old account really is closed.
7. Type the signer name under Approval by person holding tax ID shown on this form, and confirm the Tax ID.
8. Click Submit bank update. You should see "Bank account update request has been received successfully" and a status of Pending.
9. ECHO may ask for a voided check and W-9, then post micro-deposits. Enter the micro-deposit amounts in the portal to finish.

**Or: ECHO Health form by email**

Portal: [ECHO Health](https://enrollments.echohealthinc.com)

Use this when the practice has no working ECHO login. Do not use the ECHO EFT/ERA Enrollment Form, which is for new enrollments only.

Get the ECHO Draft Number and matching Draft Amount from a recent ECHO payment, from the Inquiry screen or the bank statement.

1. Get the Bank Account Update Form, Healthcare Provider (ECHO Health, Inc.). Payers host copies of it.
2. Fill in the provider name, billing address, Tax ID and email, the old bank, the new bank, and the Draft Number and Draft Amount.
3. Have the practice sign it with name, title, phone, email and date.
4. Send it to edi@echohealthinc.com, or fax 440.835.5656, or mail it to 810 Sharon Drive, Westlake, OH 44145.
5. Expect a request for a voided check and W-9, then a micro-deposit. Track the status under Provider Resources, Update Bank Account.

### Sentara Health Plans

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Shared Health Mississippi

**Shared Health**

Portal: [Payer Enrollment Services](https://payerenrollservices.com/)

1. Go to https://payerenrollservices.com/ and log in with your provider credentials.
2. Click the "PAYER LIST" tab at the top of the page.
3. Locate "Shared Health" in the Payer List.
4. Click on the payer to view or update your enrollment details.

### Simply Healthcare

**Simply Healthcare**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Simply Healthcare" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Student Resources (UnitedHealthcare)

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Summit Community Care

**Summit Community Care**

Portal: [Availity](https://apps.availity.com)

1. Go to https://apps.availity.com and log in with your Availity provider credentials.

### Surest

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### TLC Benefit Solutions

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### TRICARE for Life

**TRICARE For Life**

Portal: [Payer Enrollment Services](https://payerenrollservices.com/)

1. Go to https://payerenrollservices.com/ and log in with your provider credentials.
2. Click the "PAYER LIST" tab at the top of the page.
3. Locate "TRICARE For Life" in the Payer List.
4. Click on the payer to view or update your enrollment details.

### UFCW Local 1262 Welfare Dental Program

**UFCW Local 1262 Welfare Dental Program**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "UFCW Local 1262 Welfare Dental Program" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### UMR

**UMR**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "UMR" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### United American Insurance Company

**Optum Pay: change banking data**

Portal: [Optum Pay](https://myservices.optumhealthpaymentservices.com)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### United HealthCare Community Plan Missouri

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### United HealthCare Community Plan of Arizona

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### United HealthCare Ohio Medicaid Managed Care Entity (MCE)

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### UnitedHealthcare

**UnitedHealthcare**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "UnitedHealthcare" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### UnitedHealthcare Community Plan

**UHC Community Plan**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "UHC Community Plan" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### UnitedHealthcare Community Plan - KS (KanCare)

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### UnitedHealthcare Community Plan - Michigan, Utah

**UHC Community Plan MI Dual**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "UHC Community Plan MI Dual" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

**UHC Community Plan Michigan**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "UHC Community Plan Michigan" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### UnitedHealthcare Community Plan New Jersey

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### Unitedhealthcare Community Plan New Mexico Medicaid

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### UnitedHealthcare Community Plan of Pennsylvania

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### UnitedHealthcare Community Plan Tennessee

**Optum Pay: change banking data**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

Optum Pay is not Optum Payer Enrollment Services (the old Change Healthcare), which is a different login. Cancel any address change and do banking only, because an address change can block the form.

Needs a One Healthcare ID with admin or super admin rights, a voided check, and a W-9 dated in the current year.

1. Sign in with the One Healthcare ID and complete the SMS code.
2. Choose Providers & Organizations if prompted, then click Maintain enrollment.
3. Confirm the TIN, click Edit, open Bank accounts, then Change banking data.
4. Enter the authorized representative name, phone number and contact details.
5. Delete the existing routing number first, then enter the new routing number.
6. Enter the new account number and set the account type to Checking.
7. Upload the voided check, then attach the current-year W-9.
8. Click Update bank data. The old and pending bank show side by side.
9. Scroll to the bottom and click Finish, then Submit on the review page.
10. Check the practice inbox for the email "Notice of account change".

### UPMC Health Plan

**UPMC Provider Online: Electronic fund transfer change**

Portal: [UPMC Provider Online](https://www.upmchealthplan.com/providers/)

Nothing confirms the change in the portal after submit. Phone UPMC and ask which account they see before treating it as done. Share your entire screen, not a single Chrome tab, if screen sharing.

Have the practice legal name, the submitter title, and a voided check as a file.

1. Open the Sign in / Register dropdown at the top right, then click Office management.
2. Find Electronic fund transfer and choose Request a change from the dropdown.
3. Enter the practice legal name as Name of organization, not the bank name.
4. Enter the bank name, routing number and account number, and set the account type to Checking.
5. Enter the submitter title.
6. Choose file and attach the voided check, then attach a duplicate copy as a second file.
7. Submit.

### Veterans Affairs Community Care Network (Optum Serve)

**Optum VA CCN Region 2**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "Optum VA CCN Region 2" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

**Optum VA CCN Region 3**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "Optum VA CCN Region 3" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

**Optum VA CCN Region 5**

Portal: [Optum Health Payment Services](https://myservices.optumhealthpaymentservices.com/registrationSignIn.do)

1. Go to https://myservices.optumhealthpaymentservices.com/registrationSignIn.do and sign in with your provider credentials.
2. Locate "Optum VA CCN Region 5" in your payer list.
3. Click on the payer to view or update your payment and portal settings.

### Washington National

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### WebTPA

**Availity Payer Spaces (try this first)**

Portal: [Availity Essentials](https://essentials.availity.com)

Route not confirmed. Use this when the payer publishes its own ERA/EFT Enrollment app in Payer Spaces. No bank document is needed. Edit in place works, there is no need to cancel first.

Have an Availity login with admin rights, the Tax ID, a provider contact name, phone and email, and the new bank name, address, routing number, account number and account type.

1. Sign in to Availity Essentials, enter the emailed or texted code, then Continue.
2. In the top navigation, open Payer Spaces and use the filter box to find the payer.
3. Select the payer tile, then open ERA/EFT Enrollment in the applications grid.
4. Set Search option to Tax ID, pick the Organization, leave Enrollment status as is, then Search.
5. Open the existing enrollment to reach Change EFT Enrollment. The wizard has three steps: EFT Authorization, Contact Information, EFT Details.
6. Under EFT Authorization, set the relationship to Part of provider organization and enter the provider contact name, telephone number and email (typed twice).
7. Under EFT Details, choose the Type of account, then enter the Financial institution routing number.
8. Complete the bank name and address fields that appear once the routing number is in.
9. Enter the Financial institution account number, then retype it.
10. Submit.

**Or: Availity Transaction Enrollment (when the payer has no ERA/EFT app in Payer Spaces)**

Portal: [Availity Essentials](https://essentials.availity.com)

This route needs a bank letter or voided check. Each plan is a separate payer: read every payer block on the confirmation screen, because a batch can half succeed.

Have an Availity login with admin rights, the Tax ID and NPI, the provider name and address, a contact name, phone and email, the new bank details, and the bank letter or voided check as a PDF.

1. Set the state selector in the top right to the practice state, or the plan will not appear.
2. Open Claims & Payments, then Transaction Enrollment under EDI Clearinghouse, then Enroll and Enroll a Provider.
3. Select the organization and tick "load provider information from organization". Check the provider block, then Continue.
4. Select the plan or plans (ten at most) and Provider type Professional, then Continue.
5. Tick Electronic Funds Transfer on each plan row. If Daily and Weekly are offered, pick deliberately.
6. Answer Yes to "Do you currently receive electronic payments for this payer?", and set Account number linkage to TIN (switch to NPI if matching fails).
7. Enter the bank name, routing number, account number and account type.
8. Set Reason for submission to Change enrollment and attach the bank letter or voided check.
9. Review, tick I agree, then Submit.
10. Confirm every payer reads "Change initiated". Results are per payer, so a batch can half succeed.

### Wellcare

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Route not confirmed. Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### WellCare (Encounters)

**PaySpan Health: add the account, then assign it to each payer**

Portal: [PaySpan Health](https://payspanhealth.com)

Adding the account is not enough, you must assign it to every payer reg code. PaySpan sends test deposits within 2 to 3 business days and someone must enter the amounts or the account stays Pending. Tell the practice to expect a validation call.

Needs an admin login (without it, Accounts does not appear under Manage) and the new bank details. No voided check, W-9 or old bank details are needed.

1. Log in. A code goes to the phone on file by SMS.
2. Under Manage, open Accounts, then Create New Account.
3. Set Account Type to ACH (EFT), not plain checking.
4. Enter the Account Name, then the Type of Account at Financial Institution (Business Checking) and the Bank Routing Number.
5. Tick "The name shown above is correct", then enter the Bank Account Number twice and Save. The account shows Pending.
6. Open Manage Reg Codes, select every reg code (there is one per payer per provider, ten to a page), then click Assign Account.
7. In Change Reg Code Account, pick the new account from Receiving Account, then Save and Close.
8. When the test deposits land, enter the amounts in PaySpan to activate the account.

### Wellmark

**Wellmark Blue Dental**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellmark Blue Dental" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Wellpoint

**UniCare**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "UniCare" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (AZ)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (AZ)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (DC)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (DC)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (FL)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (FL)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (IA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (IA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (MD)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (MD)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (NJ)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (NJ)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (NY)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (NY)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (SC)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (SC)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (TN)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (TN)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (TX)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (TX)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (WA)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (WA)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint Commonwealth of Massachusetts**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint Commonwealth of Massachusetts" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Wellpoint West Virginia

**UniCare**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "UniCare" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

**Wellpoint (WV)**

Portal: [EnrollSafe / PayeeHub](https://enrollsafe.payeehub.org)

1. Go to https://enrollsafe.payeehub.org/ and log in with your provider credentials.
2. Locate "Wellpoint (WV)" in the Participating Plans list.
3. Click the payer link to view or update your EFT enrollment and payer portal settings.

### Western & Southern Financial Group

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### WPS – Family Care (FAMC)

**WPS – Family Care (FAMC)**

Portal: [Payer Enrollment Services](https://payerenrollservices.com/)

1. Go to https://payerenrollservices.com/ and log in with your provider credentials.
2. Click the "PAYER LIST" tab at the top of the page.
3. Locate "WPS – Family Care (FAMC)" in the Payer List.
4. Click on the payer to view or update your enrollment details.

### WPS (WPS-TMEP)

**EnrollSafe: cancel and re-enroll**

Portal: [EnrollSafe](https://enrollsafe.payeehub.org)

EnrollSafe cannot change a bank account in place, and an enrollment replaces all historical EFT enrollments for the entire TIN. Enumerate every TIN and NPI combination before submitting, because any left out drops to virtual card or check with third party fees. Checks may resume during the gap.

Have the practice Tax ID, the payer-issued provider ID, the new bank details and a voided check or bank letter (a front-only check image is not enough).

1. Log in to EnrollSafe, which is a different login from Availity.
2. Enter the TIN and the payer-issued provider ID, set the primary user preference, then Continue.
3. If an enrollment is active, open it, choose Actions, then Cancel. Wait until "cancel enrollment request is pending" clears.
4. Click Add bank account, then select Checking and Business.
5. Enter the account holder legal name, financial institution name, routing number and account number (twice).
6. Select File and attach the proof of account, then click Add Bank Account.
7. Link the bank to the enrollment, then Continue.
8. Submit the enrollment, tick Agree and type your name as the electronic signature.

### WPS Health Insurance

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### WPS Health Plan

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.

### Zing Health

**Zelis ACH enrollment**

Portal: [Zelis Payments](https://provider.zelispayments.com/Registration)

The ACH+ option the portal pushes carries a 1.9% fee (ZAPP Edge). If the fee appears, save and exit, then call Zelis and ask to enroll in the fee-free e-payment EFT option. Pick Gross settlement.

Have the new bank details and the Tax ID. The account owner name, account type and Tax ID must match what was used to open the account or the enrollment is delayed.

1. Sign in. Payment Selection shows the current method. If it reads Virtual credit card, that is what you are replacing.
2. Start the ACH enrollment.
3. Under Bank Account Information, enter the routing number, account number (twice), and check the auto-filled financial institution name.
4. Enter the Tax ID used to open the account, set Type of account to Checking and Ownership type to Business.
5. Enter the Account holder name exactly as the legal entity appears on the account.
6. Set the preferred settlement to Gross.
7. Under ERA Delivery, enter a name, email and telephone number, then choose a delivery option and format (Clearinghouse if the practice has one).
8. Review the whole configuration, including whether payment delivery reads Consolidated payment for all payers.
9. Tick the agreement, enter Signed by, Title and Email address, then Submit enrollment.
10. Zelis sends a micro-deposit. Payments start once it is verified.