Unicare eft enrollment form 2025

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The document contains enrollment forms for Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) services from UniCare. It outlines the necessary information required for providers to enroll, including contact details, tax identification numbers, and bank account information. The forms must be completed clearly and submitted via fax or email, with specific instructions regarding data transmission methods and vendor arrangements. Legal signatures are required to validate the submissions.

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