Arizona Eft Authorization Agreement

Here, suppliers will check the status of claims or file claims electronically. Once connected, click EFT ENROLLMENT at the top left of the screen. Note: This form can be filled out online and sent to the AHCCCS funding section, fax number 602-258-5943, but as an original signature is required, please send the original form to the address at the bottom of the screen. The electronic payment option processes payments through the Automated Clearing House (ACH). This method allows suppliers to obtain reimbursement faster than issuing a review. The Arizona Clearing Association (ACHA) processes the payment directly into the supplier`s bank account through Bank of America, which acts as a service public bank. The ACH Vendor Authorization form is used by suppliers to begin receiving the electronic refund from the Fee For service. You can fill out and send the form yourself by going to:.