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The document is a Complete TFL Enrollment Package for TRICARE for Life (TFL) providers, detailing the Electronic Funds Transfer (EFT) Authorization process. It outlines the benefits of enrolling in EFT, such as quicker payments and direct deposits to bank accounts. The document includes instructions for completing the EFT authorization agreement, provider information requirements, depository information, and contact details. Additionally, it emphasizes compliance with HIPAA regulations and provides guidelines for submitting electronic claims to Wisconsin Physicians Service Insurance Corporation (WPS).

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Click ‘Get Form’ to open the TRICARE for Life Electronic Funds Transfer (EFT) Authorization Form in the editor.
In Part I, select the reason for submission: whether it's a new EFT authorization, a revision, or a termination request.
Proceed to Part II and enter your identification data. Fill in the provider's name, legal business name, and tax identification number as required.
In Part III, provide depository information. Enter your bank's name, account holder’s details, and routing number. Ensure all fields are accurately filled to avoid processing delays.
Complete Part IV by entering the contact person's information responsible for this EFT authorization agreement.
Finally, sign and date the form in Part V to authorize WPS to initiate credit entries. Make sure no facsimile signatures are used.

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Versions	Form popularity	Fillable & printable
2013	4.9 Satisfied (62 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the TRICARE insurance?

Generally speaking, a person is TRICARE-eligible if they are on active duty, retired, or serving in the National Guard and Reserve (depending on their status and situation) or a spouse, child, or other (DEERS-registered) dependent of such a sponsor.

What kind of insurance is TRICARE?

What type of health insurance is TRICARE? TRICARE is a government-sponsored health insurance program for active duty, Reserves, retired military members, and eligible family members.