Billing Services Form Instructions, EDI Transaction Overview and More
Electronic Payment/Remittance Authorization Agreement
Use this form to enroll, change enrollment or cancel enrollment in electronic payment/remittance.
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Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, Optima Health Group, Inc., and Sentara Health Plans, Inc. Optima HMO products, related Patient Optional Point-of-Service products, Point-of-Service products, and Open Access products are underwritten by Optima Health Plan. Optima Preferred Provider Organization products are underwritten by Optima Health Insurance Company. Self-funded plans are administered by Sentara Health Plans, Inc.