Provider service credentials payment information details

This screen allows you to view or update the details of the account to which provider payments are made. Only one payment account may be in effect at a time.

In the address listing, the system displays all the current address records that have been added for this provider. The system automatically selects the provider's primary address as the one to which payments are sent, although you can change this selection. Historical payment records retain the address information in effect when the payment was made.

When you create a new payment record, the system automatically end-dates any previously entered record.

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Fields on this screen

Payment Name	Enter the provider's name as it should appear on all payments. You can enter up to 100 characters. This field is required.
Payment Method	Select the method by which payment will be made. This field is required.
Account Type	Select the type of payment account. This field is required when you select EFT as the method.
Bank Name	Enter the name of the bank where the account is held. You can enter up to 50 characters. This field is required when you select EFT as the payment method.
Account Number	Enter the number of the payment account. This field is required when you select EFT as the payment method.
Routing Number	Enter the bank's routing number. This field is required when you select EFT as the payment method.
Vendor Number	Enter the provider's vendor number.
Effective Date	Enter the date on which this payment account is in effect. Use the format MM/DD/YYYY. The system defaults to today's date. This date must be later than the effective date of any previous payment account. This field is required.
End Date	Enter the date on which this payment account is no longer in effect. Use the format MM/DD/YYYY. If a new payment account record is entered, the system automatically enters the date that is one day before the effective date of the new record.
Comments	Enter any additional information about this payment account. You can enter up to 2,000 characters.
Select (address)	Select the radio button next to the address to which the payment should be sent.