EFT ERA Authorization Agreement Instructions - Optima Health 2026

1. Click ‘Get Form’ to open the EFT ERA Authorization Agreement in the editor.
2. Begin by filling out the 'Payer / Insurance Company Name' section. Specify only one payer per form.
3. Provide your ECHO Draft Number and Draft Amount if applicable, especially for EFT enrollments.
4. Complete the 'Provider Information' section with your legal name, address, and contact details.
5. In the 'Provider Identifiers Information' section, enter your TIN or EIN and indicate if you have an NPI number.
6. Fill out the 'Financial Institution Information' with your bank's name, routing number, and account details for EFT payments.
7. For Electronic Remittance Advice (ERA) preferences, specify how you wish to receive remittance data and provide any necessary clearinghouse information.
8. Finally, complete the submission information including reason for submission and authorized signature before sending it to ECHO Health.

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