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EFT Registration

Only Emdeon's ePayment suite provides you single-enrollment access to the nation's leading healthcare payment network. Emdeon ePayment can dramatically reduce expenses, shorten the reimbursement cycle and streamline workflow through the broadest payer network in the market! Simple enrollment. Incredible benefits.

Please complete the following information and Emdeon will email you a welcome kit with instructions on next steps in the EFT enrollment process!

Organization Contact Information

*Tax ID (If you need to enroll multiple Tax IDs/facilities, please submit a separate request for each)

*Organization Name *Contact Name *Email Address *Phone Number *Street Address *City

*State

*ZIP Code

*Are you a billing service?

Yes No

*Do you use a billing service?

Yes No

System Vendor Name

*Are you an existing Claim Master Suite customer?

Yes No Not sure

Primary Contact Information

*Same as Organization Contact Information?

Yes

*EFT Contact Name *Email Address *Phone Number *Street Address *City

*State

*ZIP Code

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