Account Number Linkage to Provider Identifier Sample Clauses

Account Number Linkage to Provider Identifier. Provider Tax Identification Number (TIN) National Provider Identifier (NPI) Provider preference for grouping (bulking) claim payment remittance advice – must match preference for EFT payment Enter the provider’s preference for grouping claim payments – either by TIN or NPI. Please note that the Preference for Aggregation of Remittance Advice Data entered here must match the Account Number Linkage to Provider Identifier Data entered at the time the provider enrolled for Electronic Funds Transfer (EFT).
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Account Number Linkage to Provider Identifier. A 9-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited. The type of account the provider will use to receive EFT payments, e.g., Checking, Savings (check the appropriate box). Provider’s account number at the financial institution to which EFT payments are to be deposited (up to 10 digits). Check yes or no. If no, please provide the country of location of the account. Check one: Provider Tax Identification Number (TIN), or National Provider Identifier (NPI).
Account Number Linkage to Provider Identifier. Provider Tax Identification Number (TIN) OR National Provider Identifier (NPI) Method of Retrieval Trading Partner Secure Web Portal Safe Harbor Connectivity Reason for Submission New Enrollment Change Enrollment Cancel Enrollment I authorize the electronic remittance advice enrollment under the Connecticut Medical Assistance Program. I understand that I am responsible for the validity of the above information. Note: Paper Trading Partner Agreement forms will not be accepted after July 1, 2019. Trading Partners should go to xxx.xxxxxxxx.xxx to complete and on-line Trading Partner Agreement.
Account Number Linkage to Provider Identifier. Provider Tax Identification Number (TIN) National Provider Identifier (NPI) New Enrollment Change Enrollment Cancel Enrollment Include with Enrollment Submission Voided Check Bank Letter Electronic Signature of Person Submitting Enrollment Written Signature of Person Submitting Enrollment Printed Name of Person Submitting Enrollment Printed Title of Person Submitting Enrollment Submission Date (CCYYMMDD) Requested EFT Start/Change/Cancel Date (CCYYMMDD) AUTHORIZATION FOR SETUP I hereby authorize the State of Utah ("the State") to initiate credit entries to the account number listed above ("this account"). I further authorize the State to correct credit entries made in error to this account. I agree that this AUTHORIZATION FOR SETUP is to remain in full force and effect until the State has received written notification from me of its termination, in such time and manner as to afford the State and the Financial Institution a reasonable opportunity to act upon my notification. I recognize that if I fail to provide complete or accurate information on the above DIRECT DEPOSIT AUTHORIZATION FORM FOR ELECTRONIC FUNDS TRANSFERS (EFT) FOR MEDICAID PROVIDERS ("this form"), the processing of this form may be delayed and/or my payments may be erroneously transferred. In the event that funds are erroneously transferred due to my failure to provide complete or accurate information on this form, I hereby hold the State harmless for the recovery of such erroneous transfers, not withstanding any reasonable attempts made by the State to correct such errors. I understand that payment will be from Federal and State funds and that any falsification or concealment of a material fact, may be prosecuted under Federal and State laws.

Related to Account Number Linkage to Provider Identifier

  • Your Member Identification Card Your BCBSRI member ID card is your key to getting healthcare coverage. It shows your healthcare provider that you’re part of the nation’s most trusted health plan. All BCBSRI members receive ID cards, which provide important information about your coverage. This card is for identification only, and you must show it whenever you receive healthcare services. Please note you must be a current member to receive covered services. Tips for keeping your card safe: • Carry it with you at all times. • Keep it in a safe location, just as you would with a credit card or money. • Let BCBSRI know right away if it is lost or stolen.

  • Customer Identification Program Notice To help the U.S. government fight the funding of terrorism and money laundering activities, U.S. Federal law requires each financial institution to obtain, verify, and record certain information that identifies each person who initially opens an account with that financial institution on or after October 1, 2003. Certain of PNC’s affiliates are financial institutions, and PNC may, as a matter of policy, request (or may have already requested) the Fund’s name, address and taxpayer identification number or other government-issued identification number, and, if such party is a natural person, that party’s date of birth. PNC may also ask (and may have already asked) for additional identifying information, and PNC may take steps (and may have already taken steps) to verify the authenticity and accuracy of these data elements.

  • Customer Identification Program (A) To assist the Fund in complying with requirements regarding a customer identification program in accordance with applicable regulations promulgated by U.S. Department of Treasury under Section 326 of the USA PATRIOT Act ("CIP Regulations"), BNYM will do the following: (i) Implement procedures which require that prior to establishing a new account in the Fund BNYM obtain the name, date of birth (for natural persons only), address and government-issued identification number (collectively, the "Data Elements") for the "Customer" (defined for purposes of this Agreement as provided in 31 CFR 1024.100(c)) associated with the new account. (ii) Use collected Data Elements to attempt to reasonably verify the identity of each new Customer promptly before or after each corresponding new account is opened. Methods of verification may consist of non-documentary methods (for which BNYM may use unaffiliated information vendors to assist with such verifications) and documentary methods (as permitted by 31 CFR 1024.220), and may include procedures under which BNYM personnel perform enhanced due diligence to verify the identities of Customers the identities of whom were not successfully verified through the first- level (which will typically be reliance on results obtained from an information vendor) verification process(es). (iii) Record the Data Elements and maintain records relating to verification of new Customers consistent with 31 CFR 1024.220(a)(3). (iv) Regularly report to the Fund about measures taken under (i)-(iii) above. (v) If BNYM provides services by which prospective Customers may subscribe for shares in the Fund via the Internet or telephone, BNYM will work with the Fund to notify prospective Customers, consistent with 31 CFR 1024.220(a)(5), about the program conducted by the Fund in accordance with the CIP Regulations. (B) To assist the Fund in complying with the Customer Due Diligence Requirements for Financial Institutions promulgated by FinCEN (31 CFR § 1020.230) pursuant to the Bank Secrecy Act ("CDD Rule"), BNYM will maintain and implement written procedures that are reasonably designed to: (i) Obtain information of a nature and in a manner permitted or required by the CCD Rule in order to identify each natural person who is a "beneficial owner" (as that term is defined in the CDD Rule) of a legal entity at the time that such legal entity seeks to open an account as a shareholder of the Fund, unless that legal entity is excluded from the CDD Rule or an exemption provided for in the CDD Rule applies; and (ii) Verify the identity of each beneficial owner so identified according to risk based procedures to the extent reasonable and practicable, in accordance with the minimum requirements of the CDD Rule. (C) Nothing in Section (3) shall be construed to require BNYM to perform any course of conduct that is not required for Fund compliance with the CIP Regulations or CDD Rule, including by way of illustration not limitation the collection of Data Elements or verification of identity for individuals opening Fund accounts through financial intermediaries which use the facilities of the NSCC. (D) BNYM agrees to permit inspections relating to the CIP services provided hereunder by U.S. Federal departments or regulatory' agencies with appropriate jurisdiction and to make available to examiners from such departments or regulatory agencies such information and records relating to the CIP services provided hereunder as such examiners shall reasonably request.

  • Customer Identification Unless Elastic has first obtained Customer's prior written consent, Elastic shall not identify Customer as a user of the Products, on its website, through a press release issued by Elastic and in other promotional materials.

  • Taxpayer Identification Number; Other Identifying Information The true and correct U.S. taxpayer identification number of the Company and each Designated Borrower that is a Domestic Subsidiary and a party hereto on the Closing Date is set forth on Schedule 10.02. The true and correct unique identification number of each Designated Borrower that is a Foreign Subsidiary and a party hereto on the Closing Date that has been issued by its jurisdiction of organization and the name of such jurisdiction are set forth on Schedule 5.17.

  • Account Numbers State Street shall process all payment orders on the basis of the account number contained in the payment order. In the event of a discrepancy between any name indicated on the payment order and the account number, the account number shall take precedence and govern. Financial institutions that receive payment orders initiated by State Street at the instruction of the Client may also process payment orders on the basis of account numbers, regardless of any name included in the payment order. State Street will also rely on any financial institution identification numbers included in any payment order, regardless of any financial institution name included in the payment order.

  • No Reliance on Agent’s Customer Identification Program Each Lender acknowledges and agrees that neither such Lender, nor any of its Affiliates, participants or assignees, may rely on the Agent to carry out such Lender’s, Affiliate’s, participant’s or assignee’s customer identification program, or other obligations required or imposed under or pursuant to the USA PATRIOT Act or the regulations thereunder, including the regulations contained in 31 CFR 103.121 (as hereafter amended or replaced, the “CIP Regulations”), or any other Anti-Terrorism Law, including any programs involving any of the following items relating to or in connection with any Borrower, its Affiliates or its agents, this Agreement, the Other Documents or the transactions hereunder or contemplated hereby: (1) any identity verification procedures, (2) any record-keeping, (3) comparisons with government lists, (4) customer notices or (5) other procedures required under the CIP Regulations or such other laws.

  • Contact Numbers The Parties agree to provide one another with toll-free nation- wide (50 states) contact numbers for the purpose of ordering, provisioning and maintenance of services.

  • No Reliance on Administrative Agent’s Customer Identification Program Each Lender acknowledges and agrees that neither such Lender, nor any of its Affiliates, participants or assignees, may rely on the Administrative Agent to carry out such Lender’s, Affiliate’s, participant’s or assignee’s customer identification program, or other obligations required or imposed under or pursuant to the USA Patriot Act or the regulations thereunder, including the regulations contained in 31 CFR 103.121 (as hereafter amended or replaced, the “CIP Regulations”), or any other Anti-Terrorism Law, including any programs involving any of the following items relating to or in connection with any of the Loan Parties, their Affiliates or their agents, the Loan Documents or the transactions hereunder or contemplated hereby: (i) any identity verification procedures, (ii) any recordkeeping, (iii) comparisons with government lists, (iv) customer notices or (v) other procedures required under the CIP Regulations or such other Laws.

  • Contract Number All purchase orders issued by purchasing entities within the jurisdiction of this Addendum shall include the Participating State Addendum Number: 46151504-NASPO-17-ACS. This Addendum and Master Agreement number RFP-NK-15-001 (administered by the State of Colorado) together with its exhibits, set forth the entire agreement between the Parties with respect to the subject matter of all previous communications, representations or agreements, whether oral or written, with respect to the subject matter hereof. Terms and conditions inconsistent with, contrary or in addition to the terms and conditions of this Addendum and the Contract, together with its exhibits, shall not be added to or incorporated into this Addendum or the Contract and its exhibits, by any subsequent purchase order or otherwise, and any such attempts to add or incorporate such terms and conditions are hereby rejected. The terms and conditions of this Addendum and the Contract and its exhibits shall prevail and govern in the case of any such inconsistent or additional terms within the Participating State.

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