Common Contracts
3 similar Eft Authorization Agreement contracts
ContractEft Authorization Agreement • February 21st, 2012 • New Mexico
*This EFT Authorization Agreement form is for providers submitting Medicare Secondary or Crossover claims. It is to be used ONLY by non-contracting providers located outside of the Illinois, Montana, New Mexico, Oklahoma, Texas Blue Plan states and their contiguous counties.
ContractEft Authorization Agreement • February 21st, 2012 • Oklahoma
*This EFT Authorization Agreement form is for providers submitting Medicare Secondary or Crossover claims. It is to be used ONLY by non-contracting providers located outside of the Illinois, Montana, New Mexico, Oklahoma, Texas Blue Plan states and their contiguous counties.
ContractEft Authorization Agreement • February 21st, 2012 • Texas
*This EFT Authorization Agreement form is for providers submitting Medicare Secondary or Crossover claims. It is to be used ONLY by non-contracting providers located outside of the Illinois, Montana, New Mexico, Oklahoma, Texas Blue Plan states and their contiguous counties.
