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InstaMed Order Form - Payer Payments - CareSource 2026
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- Click ‘Get Form’ to open the InstaMed Order Form in our platform.
- Begin by filling out the 'Customer Information' section. Provide your primary contact details, including name, title, phone number, and email address. Ensure that all fields are completed accurately to avoid delays.
- Next, move to the 'Remittance Delivery' section. Indicate how you wish to receive electronic remittance advice (ERA) by listing your clearinghouse if applicable. You can also opt for SFTP delivery by checking the corresponding box.
- In the 'NPIs' section, enter your Billing Provider NPI(s). If you have Service Provider NPI(s), include them as well. Only list NPIs that should receive payments routed to you.
- Proceed to fill in the 'Bank Account Information'. Provide your bank name, routing number, and account number. Remember that a voided check or bank letter is required for verification.
- Finally, review all information for accuracy before signing in the designated signature field. Your electronic signature will be treated as a handwritten one for validity.
Start using our platform today to complete your InstaMed Order Form quickly and efficiently!
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