Instructions to Set Up an Account
To successfully authorize the use of Electronic Funds
Transfer for the Depositing of Escrow Funds into a Checking
account, the following steps must be completed.
1. Log
on EI Billing and go to:
Ø Maintenance
Ø Provider
Profile
Ø Escrow
Payment Information
2. Select
“Request
New EFT Account Setup”
3. Input
the following financial information:
a. Routing
Number
b. Confirm
Routing Number
c. Account
Number
d. Confirm
Account Number
§ Both
the routing and account numbers can be found at the bottom of your check
e. Account
description will be populated automatically
f.
Email Address,
please enter email address for the person who is responsible for account
information this may or may not be the email address currently in EI Billing
g. Confirm
Email Address
4. Select
“Generate
Form”, which will bring you to a pre-filled PDF form
a. Check
box, “Check here if requesting initial setup of EFT Deposit”
b. Confirm
that the information on the pre-filled PDF form is correct
c. Print
the form and close the PDF
d. If
correct than select “Yes the form printed correctly”
e. Once
submitted you will not be allowed to re-print
5. Select
“Submit”
– request will go to the Escrow Accounting Department at PCG
6. Complete
Section IV, Provider Signature and Authorization
a. The
printed copy of the form must be signed by the Provider or designated practice
or business representative, and
include the date signed
b. If
the account is a joint account, both signatures must be provided
7.
Send the signed Agreement Form and one of the
following banking documents to PCG
a.
For Checking Accounts, with checks: An original blank check from the checking
account to which the funds are to be transferred from PCG. The word “VOID” must
be written across the face of the check. The check must contain the name and
address of the Provider or Provider organization.
b.
Deposit only checking accounts, do not have
checks: Accepted with the following documentation:
i.
An
original letter from the bank officer. The
letter must be on bank letterhead, signed by bank officer, notarized by a
notary public, and include the following:
1.
The Bank’s name and address
2.
Routing
number
3.
The type of account
4.
Account number
5.
The account owner’s name
6.
Owner’s address
7.
Owner’s tax ID
8.
The Agreement Form and supporting banking
documents can be sent to PCG via one of the following:
a.
Secure Fax: 1-518-338-1580
Attention:
Escrow Accounting
b.
U.S.
Postal: Public Consulting Group
200 International Drive
Suite 160
Portsmouth, NH 03801
Attention: Escrow Accounting
* EFT
Authorization Agreement Forms that do not comply with these instructions will
be rejected
What to Expect
·
Allow a minimum of 4-6 weeks for your request to
be processed.
·
During the process period a test transaction for
0 dollars will be transferred to the Provider’s account.
·
Provider will be notified that the test transaction
has passed or failed.
·
If the transaction fails, the Provider will need
to start the enrollment process again.
·
Due to normal banking procedures, the funds may
not become available in the Provider’s chosen account for up to 48 hours from
the initial transfer. Contact your banking institution with questions about the
availability of funds.
Instructions to Withdraw an EFT
request
Provider may withdraw their request for an EFT account
set-up prior to the EFT payment being approved by the SFA.
1.
Log on EI Billing and go to:
Ø Maintenance
Ø Provider
Profile
Ø Escrow
Payment Information
2.
Select “Request Cancellation”
*Please note that
if an EFT has already been approved by the SFA and you wish to generate a paper
check follow the Instructions to Cancel EFT Transactions.
Instructions to Change Banking
Information
1. Follow
the instructions above for setting up an account
2. In
addition:
o On
Agreement Form check box for “Check here if requesting change from current EFT
Deposit”
o Send
a letter indicating changes to your account with the new authorization form.
The letter must be on company letterhead and include any Provider number(s) (TIN
and NPI), the new account number and/or routing number, and a brief explanation
for the change. The letter must be signed.
*Payments will continue in your current
account until the new account has been approved
Instructions to Cancel EFT
Transactions
1.
Log on EI Billing and go to:
Ø Maintenance
Ø Provider
Profile
Ø Escrow
Payment Information
2.
Select “Request Cancellation”
3.
Select “Generate Cancellation Form”
4.
Print form and Complete Section III Provider Signature
and Authorizationand send to PCG via secure fax or U.S. Postal Service (see step 8
under “Instructions to Set Up an Account)
* Allow 4-6 weeks
to transition to a paper check