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Claims

Electronic Funds Transfer

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.

Note: Do not fax medical documentation or claims containing patient information to the HNFS Finance Department.

 

  • Created: Jun 16, 2014
  • Modified: Aug 28, 2020
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W-9 Fax Cover Sheet

Health Net Federal Services, LLC (HNFS) requires the submittal of a Request for Taxpayer Identification Number and Certification (W-9) form in order to issue claims payment for Patient-Centered Community Care and Veterans Choice Program claims.

Please use this W-9 Cover Sheet and fax a legible copy of your W-9 to HNFS at 1-844-836-5818.

  • Created: Aug 16, 2018
  • Modified: Feb 7, 2018
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