EFT Enrollment Authorization AgreementEnrollment Authorization Agreement • July 14th, 2017
Contract Type FiledJuly 14th, 2017Please type directly into this form or print clearly. Please complete all required information. All * fields are required.
EPS EFT Enrollment Authorization AgreementEnrollment Authorization Agreement • November 22nd, 2013 • Minnesota
Contract Type FiledNovember 22nd, 2013 JurisdictionOptum is improving service to you by replacing paper checks and Explanation of Benefits (EOBs) with the Optum EPS solution. Get a head start by enrolling today! For more information about this enrollment form, please see the Electronic Payments & Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website https://myservices.optumhealthpaymentservices.com/portal/server.pt.
EPS EFT Enrollment Authorization AgreementEnrollment Authorization Agreement • September 29th, 2011 • Minnesota
Contract Type FiledSeptember 29th, 2011 JurisdictionOptum is improving service to you by replacing paper checks and Explanation of Benefits (EOBs) with the Optum EPS solution. Get a head start by enrolling today! For more information about this enrollment form, please see the Electronic Payments & Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website https://myservices.optumhealthpaymentservices.com/portal/server.pt.
EPS VCP Enrollment Authorization AgreementEnrollment Authorization Agreement • September 29th, 2011 • Minnesota
Contract Type FiledSeptember 29th, 2011 JurisdictionOptum is improving service to you by replacing paper checks and Explanation of Benefits (EOBs) with the Optum EPS Virtual Card Payment (VCP) solution. No banking information is required for this payment option. VCPs are payment card transactions that you process via your point of sale terminal, similar to the way patient co-pays would be processed. VCP transactions are subject to additional terms and conditions, including fees, between you and your card service processor. Get a head start by enrolling today! For more information about this enrollment form, please see the Electronic Payments & Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website https://myservices.optumhealthpaymentservices.com/portal/server.pt.
EPS EFT Enrollment Authorization AgreementEnrollment Authorization Agreement • September 29th, 2011 • Minnesota
Contract Type FiledSeptember 29th, 2011 JurisdictionOptum is improving service to you by replacing paper checks and Explanation of Benefits (EOBs) with the Optum EPS solution. Get a head start by enrolling today! For more information about this enrollment form, please see the Electronic Payments & Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website https://myservices.optumhealthpaymentservices.com/portal/server.pt.