Fill a Valid Iowa 470 4202 Template

The Iowa 470-4202 form is an essential document for healthcare providers participating in the Iowa Medicaid Program, specifically designed for Electronic Funds Transfer (EFT) authorization. This form streamlines the process of receiving Medicaid payments directly into a provider's bank account, ensuring timely and efficient transactions. When completing the form, providers must provide crucial information, including their name, Taxpayer ID, and National Provider Identifier. Additionally, details about the financial institution, such as the bank's name, ABA routing number, and account number, must be included. It's important to note that providers are required to submit a voided check or a bank verification letter to validate their account information. By signing the form, the authorized person certifies their understanding of the implications of receiving payments from state and federal funds, including the legal responsibilities associated with any misrepresentation. The completed form should be returned to the Provider Services Unit at the Iowa Medicaid Enterprise, either by mail or fax. This process not only facilitates a smoother payment experience but also reinforces the importance of accuracy and integrity in the Medicaid billing system.