Provider Electronic Funds Transfer (EFT) Enrollment Form

EMI Health is pleased to offer the convenience, savings and security of having your claims payments remitted electronically to your bank account (electronic funds transfer). This will save you the time and trouble of depositing checks, as well as allow you to receive payment more timely.

In order to enroll in this paperless method of payment, you must be receiving electronic remittance advices (835) from EMI Health. The 835 is a fully electronic report containing claim adjudication details, including payments and adjustments. If you are not sure of your 835 status, ask your clearinghouse whether you are enrolled to receive 835 reports from EMI Health. If you are not able to verify this information through your clearinghouse, EMI Health's clearinghouse, UHIN, can check your enrollment status. Call UHIN at (877) 693-3071.

Once you are actively accepting EDI 835s from EMI Health, fill out the information below to enroll.

If you have any questions, please contact our office at (801) 262-7476 or toll free at (800) 662-5850.

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Currently receiving ERAs (835)

Prior to enrolling for EFT with EMI Health, you must be registered with UHIN and receiving electronic remittance advices (ERA or 835) from EMI Health. Once you receive your first ERA (835) from EMI Health, you may complete this EFT enrollment form.

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