TMPPM 2008 > Provider Information > Texas Medicaid Reimbursement > Reimbursement

2.1.1.3 Enrollment Procedures

The Electronic Funds Transfer (EFT) Authorization Agreement can be requested by contacting the Provider Enrollment department at 1-800-925-9126. Completed EFT forms can be faxed to 1-512-514-4214. Please include:

•EFT Enrollment Form.

•Organization name.

•Contact name.

•Address.

•Contact telephone number.

•Contact fax number.

To enroll for EFT, providers must submit a completed Electronic Funds Transfer (EFT) Authorization Agreement to TMHP. A voided check or copy of a deposit slip must be attached to the enrollment form. One form should be filled out for each billing provider identifier, including an original signature of the provider.

TMHP issues a prenotification transaction during the next cycle directly to the provider's bank account. This transaction serves as a checkpoint to verify EFT is working correctly.

If the bank returns the prenotification without errors, the provider will begin receiving EFT transactions with the third cycle following the enrollment form processing. The provider will continue to receive paper checks until they begin to receive EFT transactions.

If the provider changes bank accounts, the provider must submit a new Electronic Funds Transfer (EFT) Authorization Agreement to Provider Enrollment. The prenotification process is repeated and, once completed, the EFT transaction is deposited to the new bank account.

Refer to: "Electronic Funds Transfer (EFT) Authorization Agreement".