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Echo eft enrollment form pdf

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The document is an enrollment form for Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) provided by ECHO Health, Inc. It includes instructions for completing the form, contact information for inquiries, and sections to fill out provider and financial institution details. The form allows for new enrollments, changes, or cancellations of existing enrollments.

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Got questions?

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 EFT enrollment form?

Use this form to enroll in Direct Deposit of your federal payment from the General Services Administration.

What is EFT enrollment?

If have any questions, please call our Provider Relations team at 800-700-3874, ext. 5504. If you have additional questions regarding your payment options, please contact ECHO Health at 888-984-0804. For assistance with any technical support issues, contact ECHO Health customer service at 888-834-3511.

How do I contact echo provider payments?

a. To opt-out ahead of launch: Go to and use your Tax ID and the verification access code provided in ECHOs first letter to select your payment preferences. b. To opt-out after launch: Follow the instructions on the VCC payment document.

How do I check the status of ECHO Health EFT enrollment?

To check the status of an EFT enrollment, contact ECHO customer support at 1-888-834-3511.

Does ECHO Health charge for EFT?

There are no direct charges to you from EmblemHealth, PNC or ECHO for standard EFT/ERA, VCard or check payments, or for enrollment or portal services. Your bank may charge you fees for receiving EFT payments or depositing checks.

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How to change medicare EFT information?

To change your current EFT information, please complete an Electronic Funds Transfer (EFT) Authorization Agreement Form (CMS-588). Under section 1, check the box for change to current EFT enrollment.