[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-286659-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-286659-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","automated-clearing-house-ach-vendor-payment-authorization-form","Automated Clearing House - ACH Vendor Payment Authorization Form","","This document serves as the official Automated Clearing House (ACH) Vendor Payment Authorization Form for Centene Corporation. It facilitates the enrollment process for vendors seeking to receive payments via direct electronic deposit. The form mandates the collection of essential vendor details, including contact information and verified financial institution data such as bank name, routing transit numbers, and account specifics. By completing this authorization, vendors provide legal consent for Centene Corporation to process electronic credits and corrective debits to the specified accounts. Furthermore, the document outlines procedural requirements for remittance delivery and the formal protocol for terminating electronic payment services, ensuring a secure and efficient accounts payable workflow. 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Payments will be electronically deposited into your company's designated bank account below through ACH. An ACH payment remittance advice will be delivered via the email address specified on the form below. ACH terms are NET 30, but the contractual terms can override this. The form is to be completed by the vendor and must contain the signature of a company authorized individual. |\n| --- | --- |\n| Vendor Name |  |\n| Contact Name |  |\n| Contact Title |  |\n| Email for ACH remittance (required) |  |\n| Financial Institution Information |  |\n| Bank Name |  |\n| Nine-Digit ACH Routing Transit Number |  |\n| Account Number |  |\n| Account Type |  |\n| Authorization |  |\n| I hereby authorize Centene Corporation to electronically credit the account above for payments (and, if necessary, electronically debit the account to correct erroneous credits). I understand that this authorization will remain in full force and effect until Centene Corporation receives written notification of its termination. Notification must be sent to ACCOUNTSPAYABLE@CENTENE.COM at least three (3) days in advance of the effective date of termination. |  |\n| Name |  |\n| Signature (required) |  |\n| Title |  |\n| Date |  |\n|  |  |\n| SCAN FORM & EMAIL TO APVENDORFORMS@CENTENE.COM OR FAX COPY TO 314-558-2430 (must include signature) |  |","cbCaiakGy969cG5a","https://ap.wps.com/l/cbCaiakGy969cG5a","pdf",204371,"English","# ACH Vendor Payment Authorization Process\n## Vendor and Contact Information\n## Financial Institution Details\n## Authorization and Submission Protocols","[{\"question\":\"What is the purpose of this form?\",\"answer\":\"The form is used by vendors to authorize Centene Corporation to make payments directly into their designated bank accounts via the Automated Clearing House (ACH) system.\"},{\"question\":\"How will vendors receive payment advice?\",\"answer\":\"An ACH payment remittance advice will be delivered electronically to the email address specified by the vendor on the form.\"},{\"question\":\"How can a vendor terminate this ACH payment agreement?\",\"answer\":\"Vendors must provide written notification of termination to ACCOUNTSPAYABLE@CENTENE.COM at least three days in advance of the desired effective date.\"}]","Automated Clearing House - ACH Vendor Payment Authorization Form | PDF",1789631395]