Change healthcare eft 2026

1. Click ‘Get Form’ to open the Change Healthcare EFT Enrollment form in the editor.
2. Begin by filling out the Provider Information section. Enter your Provider Name, Doing Business As (DBA) name, and complete the address fields including Street, City, State/Province, Zip Code/Postal Code, and Country Code.
3. In the Provider Identifiers Information section, provide your Federal Tax Identification Number (TIN) or Employer Identification Number (EIN), along with your National Provider Identifier (NPI).
4. Complete the Provider Contact Information sections. You will need to enter details for at least two contacts including names, titles, telephone numbers, email addresses, and fax numbers.
5. Fill in the Provider Agent Information if applicable. This includes the agent's name, address, contact information, and title.
6. Review the acknowledgment section carefully. By signing here, you confirm that all provided information is accurate and agree to comply with Change Healthcare’s terms.
7. Finally, submit your completed form via email to EFTEnrollment@ChangeHealthcare.com or fax it to 615-238-9615.

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