01. Edit your echo health eft enrollment online
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2019 era enrollment-2026
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- Click ‘Get Form’ to open the 2019 era enrollment form in the editor.
- Begin by entering the Payer/Insurance Company Name. Ensure you specify only one payer per form for clarity.
- Provide your ECHO Draft Number and Draft Amount if applicable, especially for EFT enrollments. Note that these fields are not required for ERA only.
- Complete the Provider Information section, including your legal name, address, city, state, and ZIP code.
- Fill in your Provider Identifiers Information by entering your TIN or EIN and indicating whether you have an NPI number.
- If enrolling for EFT, provide Financial Institution Information such as the bank's name, routing number, account type, and account number.
- For ERA enrollments, complete the Electronic Remittance Advice Information section detailing your retrieval method and clearinghouse information.
- Finally, sign the form and submit it via fax or secure email to ECHO Health. Ensure all required fields are completed before submission.
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