Get Tmhp Eft Form

The Tmhp EFT Form is an essential document for providers who wish to receive payments electronically. This guide will help you navigate the form step-by-step, ensuring a smooth and accurate completion process.

Follow the steps to successfully complete the Tmhp EFT Form.

1. Click the ‘Get Form’ button to obtain the Tmhp EFT Form and open it for online completion.
2. Indicate the type of authorization by selecting either 'New' or 'Change' in the designated section.
3. Fill in your provider name in the provided space.
4. Enter your Billing TPI, consisting of a 9-digit number.
5. Provide your National Provider Identifier (NPI) or Atypical Provider Identifier (API).
6. Input your primary taxonomy code.
7. If applicable, list any additional TPIs that use the same provider information in the designated fields.
8. Complete the provider accounting address section, including number, street, suite, city, state, and ZIP code.
9. Fill out your provider phone number.
10. Provide your bank name and bank phone number.
11. Enter your bank’s ABA/Transit number.
12. Fill in your account number.
13. Complete the bank address as required.
14. Select the account type from the options: Checking or Savings.
15. Read the authorization statement and provide your authorized signature, date, title, e-mail address (if applicable), contact name, and contact phone number.
16. Return the completed form to the address provided, ensuring you attach a voided check or a signed letter from your bank on bank letterhead.

Complete the Tmhp EFT Form online to streamline your payment process today!