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Provider Enrollment on the Portal Instructions
Important: You must be enrolled in Traditional Medicaid before enrolling in CSHCN or Texas Health Steps. Select "Add to an Existing Enrollment," then click "Apply Filters" if you would like instructions for adding CSHCN or Texas Health Steps to your existing enrollment.
Page Filters
These pages will guide you through each stage of the enrollment process using PEP. To customize this page's content, use the filters below and click the Apply Filters button.

Application Type:

Program(s):

Enrolling As:

Electronic Funds Transfer (EFT) Form

Instructions for Completing the Electronic Funds Transfer (EFT) Form

Note: This page does not apply to Ordering and Referring Providers.

Note: This page does not apply to Performing Providers.

Note: This page does not apply for Revalidation.

  • Complete all of the fields that are marked with red dots, or select “I do not wish to participate in the EFT program.”
  • If you want to participate in EFT, you must electronically attach a voided check or a signed letter from your bank on bank letterhead on the E-Sign page at the end of this application.
  • If you are re-enrolling a TPI that is currently enrolled in EFT and you choose not to participate, your EFT will be end-dated and paper checks will be mailed to you.

    • Section: Prepopulated Information

  • The following information will be automatically populated using your responses on the previous pages:
  • Provider Information
  • Provider Name
  • Doing Business as Name (DBA)
  • Provider Address
  • Street
  • City
  • State/Province
  • Zip Code/Postal Code
  • Country Code
  • Provider Identifier Information
  • Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN)
  • Provider License Number
  • National Provider Identifier (NPI)
  • License Issuer
  • Provider Type
  • Provider Taxonomy Code
  • Other Identifiers:
  • Assigning Authority
  • Trading Partner ID
  • Other Identifier

    • Section: Optional Information

  • The following sections contain fields that are optional except Provider Contact Information:
  • Provider Contact Information — You must enter a valid email address.
  • Provider Agent Information — The fields in this section are optional. If you don’t have any additional provider agent information to add, you can leave this section collapsed.
  • Federal Agency Information — The fields in this section are optional. If you don’t have any additional federal agency information to add, you can leave this section collapsed.
  • Retail Pharmacy Information — The fields in this section are optional. If you don’t have any additional retail pharmacy information to add, you can leave this section collapsed.
      • Section: Financial Institution Information
    • Enter the name of your financial institution.
    • Enter the 9-digit routing number of your financial institution.
    • Enter the address of your financial institution.
    • You must enter the street, city, state/province, and ZIP code/postal code.
    • Enter the type of account (e.g., checking, savings).
    • Enter the account number at the financial institution where your EFT payments will be deposited.
    • Select your preference for how you want your account number linked to your provider identifier.
    • Click Continue and Save.
     
    Contents
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