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Magellan eft enrollment 2026
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- Click ‘Get Form’ to open the magellan eft enrollment form in the editor.
- Begin by filling out the Company/Partnership Information section. Enter your Company/Partnership Name, Address, City, State, and ZIP Code. Ensure all details are accurate for smooth processing.
- Provide the Billing Contact Name, Contact Telephone Number, E-Mail Address for Remittance Information, and your Taxpayer Identification Number (TIN). Select the Type of TIN you are using: Employer Identification Number or Social Security Number.
- Next, complete the Bank Information section. Fill in your Bank Name and address details. Include a Bank Contact name and their telephone number. Specify the Type of Account (Checking or Savings) and provide the Account Name, Account Number, and 9-Digit Bank Routing Number.
- In the EFT Election Information section, authorize Magellan Health to initiate credit entries by signing where indicated. Include your Title and Date of signing.
- Finally, return this completed form via U.S. mail, e-mail or fax to Magellan Health at the provided contact information.
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Related links
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