Use this form to request, make changes to or cancel payments via electronic funds transfer (EFT). Fax the completed form with a voided check or bank letter to 1-844-951-0689.
For new enrollments, please allow four weeks for the registration process to be completed, which includes pre-note verification. If after four weeks you do not start receiving EFT, please email the Health Net Federal Services, LLC (HNFS) Finance Department at HNFS_VA.Provider_EFT_ERA@healthnet.com.
Note: Do not fax medical documentation or claims containing patient information to the HNFS Finance Department.
**Visit our Claims page for electronic remitance advice (ERA) enrollment information.**
- Created: Jun 16, 2014
- Modified: Dec 30, 2019
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Health Net Federal Services, LLC (HNFS) requires the submittal of a Request for Taxpayer Identification Number and Certification (W-9) form in order to issue claims payment for Patient-Centered Community Care and Veterans Choice Program claims.
Please use this W-9 Cover Sheet and fax a legible copy of your W-9 to HNFS at 1-844-836-5818.
- Created: Aug 16, 2018
- Modified: Feb 7, 2018
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