Use this form to request, make changes to or cancel payments via electronic funds transfer (EFT). Fax the completed form with a voided check or bank letter to 1-844-951-0689.
For new enrollments, please allow four weeks for the registration process to be completed, which includes pre-note verification. If after four weeks you do not start receiving EFT, please email the Health Net Federal Services, LLC (HNFS) Finance Department at HNFS_VA.Provider_EFT_ERA@healthnet.com.
Note: Do not fax medical documentation or claims containing patient information to the HNFS Finance Department.
**Visit our Claims page for electronic remitance advice (ERA) enrollment information.**
- Created: Jun 16, 2014
- Modified: Dec 30, 2019
- View »