Optum eps eft user authorization agreement 2026

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The document is an enrollment authorization agreement for the Optum EPS (Electronic Payments and Statements) solution, which aims to replace paper checks and Explanation of Benefits with electronic payments. It outlines the necessary information required from healthcare providers, including provider identifiers, financial institution details, and submission requirements. The agreement also includes terms and conditions regarding ACH payments, security measures, liability limitations, and communication protocols. Providers must submit a completed W-9 form along with their enrollment to ensure accurate processing.

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Click ‘Get Form’ to open the Optum EPS EFT User Authorization Agreement in the editor.
Begin by filling out the 'Provider Information' section. Ensure you complete all required fields marked with an asterisk (*), including your Provider Name, Address, and Contact Information.
Next, move to the 'Provider Identifiers Information' section. Here, input your Federal Tax Identification Number (TIN) or Employer Identification Number (EIN), National Provider Identifier (NPI), and select your Provider Type from the options provided.
In the 'Financial Institution Information' sections, provide details for both TIN and NPI accounts. This includes Financial Institution Name, Address, Routing Number, and Account Number. Make sure to indicate whether it’s a Checking or Savings account.
Complete the 'Submission Information' section by indicating whether you will submit a Voided Check or Bank Letter for verification. Remember to tape a voided check if applicable.
Finally, ensure that an authorized individual signs the form in the designated area and provides their contact information before submitting it via fax or mail as instructed.

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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 ACH addendum record for Optum?

ACH Addenda is the payment reference information sent to your bank account associated with the electronic claims payment. EPS Enrollment utilizes the Cash Concentration or Disbursement CCD ACH addenda format.

What is an EFT authorization agreement?

Completing the Medicare Enrollment Application - Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) application. The Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) application is used to have your Medicare payments deposited directly into your bank account.

How does Optum pay work?

UnitedHealth Group has two distinct business platforms: Optum and UnitedHealthcare. This cohesive partnership offers an array of health services and health benefits.

What is Optum EPS?

Electronic Payments Statements (EPS) is a tool designed to make your claim payment reconciliation process quicker and more efficient by eliminating paper checks and receiving electronic payments and remittance advices online.

Is there a fee for Optum Pay?

*Activation of the full Optum Pay solution is required to access these features. Fees will apply at a rate of 0.5% per consolidated payment ($5 for every $1,000 in payments.) Fees will be billed monthly, and taxes may apply.

Optum eps eft user authorization agreement 2026

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How to use or fill out optum eps eft user authorization agreement with our platform

See more optum eps eft user authorization agreement versions

Complete this form in 5 minutes or less

Got questions?

What is the ACH addendum record for Optum?

What is an EFT authorization agreement?

How does Optum pay work?

What is Optum EPS?

Is there a fee for Optum Pay?

Security and compliance

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Optum eps eft user authorization agreement 2026

Here's how it works

How to use or fill out optum eps eft user authorization agreement with our platform

See more optum eps eft user authorization agreement versions

Complete this form in 5 minutes or less

Got questions?

What is the ACH addendum record for Optum?

What is an EFT authorization agreement?

How does Optum pay work?

What is Optum EPS?

Is there a fee for Optum Pay?

eps instructions

Security and compliance

eft 10

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