Enrollment Authorization Agreement Sample Contracts

EPS EFT New Enrollment Authorization Agreement
Enrollment Authorization Agreement • June 15th, 2016 • Minnesota

Optum is improving service to you by replacing paper checks and Explanation of Benefits (EOBs) with the Optum EPS solution. Get a head start by enrolling today! For more information about this enrollment form, please see the Electronic Payments & Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website https://myservices.optumhealthpaymentservices.com/portal/server.pt.

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EPS EFT new enrollment authorization agreement
Enrollment Authorization Agreement • August 31st, 2015

by enrolling today! For more information about this enrollment form, please see the Electronic Payments and Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website. https://myservices.optumhealthpaymentservices.com/portal/server.pt.

EPS VCP Enrollment Authorization Agreement
Enrollment Authorization Agreement • September 29th, 2011 • Minnesota

Optum is improving service to you by replacing paper checks and Explanation of Benefits (EOBs) with the Optum EPS Virtual Card Payment (VCP) solution. No banking information is required for this payment option. VCPs are payment card transactions that you process via your point of sale terminal, similar to the way patient co-pays would be processed. VCP transactions are subject to additional terms and conditions, including fees, between you and your card service processor. Get a head start by enrolling today! For more information about this enrollment form, please see the Electronic Payments & Statements EFT Enrollment Instructions by choosing the “How to Enroll” tab from the Optum EPS website https://myservices.optumhealthpaymentservices.com/portal/server.pt.

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