EFT Enrollment Instructions - BLC

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Bankers Healthcare Provider Services
Online Electronic Funds Transfer Enrollment
Submitting the Online EFT Enrollment authorizes any of the following insurance companies to pay assigned Medicare Supplemental Insurance benefits to the named provider via electronic funds transfer.
  • Washington National Insurance Company (800-541-2254)
  • Conseco Life Insurance Company (800-525-7662)
  • Colonial Penn Life Insurance Company (800-800-2254)
  • Bankers Life and Casualty Company (Ph. 800-621-3724)
  • Bankers Conseco Life Insurance Company* domiciled and licensed in the state of New York (800-845-5512)

Note: The provider must contact its financial institution to arrange for the delivery of the CORE required minimum CCD+ data elements needed for re-association of the payment and the ERA.

If you prefer to submit the enrollment form by mail, a downloadable version of the form is available here. Please allow two weeks for the enrollment process. If after two weeks you do not start receiving EFT payments or if you have any questions about enrollment, please contact us at ACHMedSupp@CNOinc.com
Instructions for Completing Electronic EFT Enrollment
Below describes each field displayed on the Online EFT Enrollment screen. Fill out each section and click "Submit" once finished. To enroll multiple National Provider Identification Numbers with the same Tax Identification Number, please click "Next" at the bottom of the screen. If you wish to exit the enrollment screen without submitting or saving your information, click "Cancel".
Provider Information
Provider Name- Complete legal name of institution, corporate entity, practice or individual provider.
Physical Address- Number and street name where a person or organization can be found.
City-  City associated with provider address field.
State-  State of the applicable Country
Zip Code-  5 digit zip code
Tax Id Number-  The provider's Tax Identification Number (TIN)
NPI-  The provider's National Provider Identifier (NPI)
Primary Provider Contact Information
Name-  Name of a contact in provider office for handling EFT issues.
Title-  Title of the person listed as provider contact.
Telephone Number-   Associated with contact person.
Email Addresses-  An electronic mail address at which the health plan might contact the provider.
Financial Institution Information
Financial Institution Name-  Official name of the provider's financial institution.
Street-  Number and street name of the financial institution.
City-   City associated with provider address field.
State-   State of the applicable Country
Zip Code-   5 digit zip code
Financial Institution Routing Number-  A 9-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited.
Account Title -   Name on bank account.
Account Number-   Providers account number at the financial institution to which EFT payments are to be deposted.
Type of Account -  Type of account the provider will use to receive EFT payments. (Checking or Savings).
Account Number Linkage to Provider Identifier-   Provider preference for grouping (bulking) claim payments-must match preference for V5010x12 835 remittance advice. You must choose one of two options: Providers Tax Identification Number (TIN) or National Provider Identifier (NPI), and input the corresponding identification number.
Reason for Submission-   Must select one of two options: New Enrollment or Cancel Enrollment
Authorization   By checking the displayed box, the provider attests that they are a duly authorized representative of the provider named above and possess the requisite authority to enroll such provider in the J.P. Morgan Healthcare LinkSM system. They also acknowledge that registration for the Healthcare LinkSM system is internet based and requires a valid email address to initiate the registration process and authorize CNO Services, LLC to transmit a Healthcare LinkSM Plan Registration Code to each email address provided above and to conduct additional electronic communications with the primary and/or secondary contact individuals as reasonably necessary in connection with such registration or enrollment.

Printed Signature-   Name of user submitting the EFT Enrollment request.

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