Electronic Funds Transfer (EFT) Forms

Horizon NJ Health has updated its Electronic Funds Transfer (EFT) forms for providers who wish to use EFT to receive payments. Please review the EFT Enrollment Flier EFT Enrollment Flier for information and instructions for enrolling in EFT.

For more information, refer to the Provider Administrative Manual, Section 9.3.1: Hardware/Software Requirements.

Pdf ImageERA Provider Setup Form

Pdf ImageChange Healthcare EPayment Enrollment Authorization Form

Payer Add/Change/Delete Authorization Form

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