Get Below Is A Copy Of An Email That We Received From Masshealth On ... - Massoptom

This guide provides a clear and concise overview of how to fill out the necessary information in the MassHealth Electronic Funds Transfer (EFT) form. By following these steps, users can efficiently ensure that their payment information is properly submitted online.

Follow the steps to complete the MassHealth EFT form online.

1. Click the ‘Get Form’ button to obtain the EFT form and open it in your preferred online document editor.
2. Review the form requirements outlined in the email. Ensure that you have all necessary documentation ready for submission.
3. Begin filling out the form by providing your Tax Identification Number and MassHealth Provider Number, leaving the latter blank if you are a new provider.
4. Indicate your provider name, including any 'doing business as' name and full address.
5. Enter your bank's information, including the Bank Name, Bank Transit Routing Number, and Bank Account Number. Choose the type of account (Checking, Savings, Lock Box) that you wish for the funds to be deposited into.
6. Sign the form using your authorized signature and fill out your name, title, and date. Include your email for confirmation.
7. Attach a voided check or a bank statement from the designated account to ensure the accuracy of your request.
8. After completing the form and attaching the required documents, mail the application to MassHealth at the address provided in the email.

Complete your MassHealth EFT form online to ensure timely processing of your payments.