Please upload a voided check and/or bank letter
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Health Plan of San Mateo (HPSM) is committed to timely, accurate, and efficient payment to providers and has a
policy to use EFT and ERA as the primary method of payment and remittance advice communication. This EFT/ERA
Authorization Form is the consent of your organization to receive payments through EFT and access remittance
advice information either through a secure HPSM portal or through a billing clearinghouse via 835 file transaction.
This EFT/ERA Authorization Form will remain in effect unless changed or cancelled by your organization using this