Common Contracts
2 similar Authorization Agreement contracts
Authorization Agreement – Instructions and Enrollment FormAuthorization Agreement • March 20th, 2021
Submission of the Full Electronic Solution form allows Delta Dental of New Jersey and Connecticut, Delta Dental member companies and their affiliates to support National EFT and National Electronic EOBs. Please note that changes or termination to your EFT will result in termination of ERA. General Instructions National ERA Enrollment is offered to offices enrolled in National EFT. National EFT enrolls your office in Direct Deposit across all Delta Dental member companies. Enrollment in National ERA allows you to obtain your claim detail for all Delta Dentals in the same format, same location (www.deltadental.com) and with the same username and password as www.deltadentalnj.com. Contact Information Delta Dental of New Jersey, Inc. Professional Services Department Phone 800-494-4137Fax 973-285-4192ddsrelations@deltadentalnj.com Enrollment in EFT/ERA Please allow up to thirty days (30) to complete EFT/ERA newand changes to enrollment.
Authorization Agreement – Instructions and Enrollment FormAuthorization Agreement • March 19th, 2021
Submission of the Full Electronic Solution form allows Delta Dental of New Jersey and Connecticut, Delta Dental member companies and their affiliates to support National EFT and National Electronic EOBs. Please note that changes or termination to your EFT will result in termination of ERA. General Instructions National ERA Enrollment is offered to offices enrolled in National EFT. National EFT enrolls your office in Direct Deposit across all Delta Dental member companies. Enrollment in National ERA allows you to obtain your claim detail for all Delta Dentals in the same format, same location (www.deltadental.com) and with the same username and password as www.deltadentalnj.com. Contact Information Delta Dental of New Jersey, Inc. Professional Services Department Phone 800-494-4137Fax 973-285-4192ddsrelations@deltadentalnj.com Enrollment in EFT/ERA Please allow up to thirty days (30) to complete EFT/ERA newand changes to enrollment.
