BeniComp IncentiCare - Provider ACH Payment Authorization

BeniComp IncentiCare - Provider ACH Payment Authorization

Please complete this form with your organization's banking information to authorize BeniComp to disperse your funds via ACH.

The ASC X12N Health Care Claim Payment/Advice (835) transaction, also known as the Electronic Remittance Advice (ERA) is used by health plans to communicate details concerning the adjudication of a claim.

A common method for transmitting an EFT is via the Automated Clearing House (ACH) network, utilizing the NACHA Cash Concentration/Disbursement plus Addenda (CCD+) format. Placement of the TRN segment of the ASC X12N Health Care Claim Payment/Advice into the Addenda record of the CCD+ allows the provider to re-associate the payment with the ERA.