Magellan eft enrollment 2026

1. Click ‘Get Form’ to open the magellan eft enrollment form in the editor.
2. 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.
3. 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.
4. 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.
5. In the EFT Election Information section, authorize Magellan Health to initiate credit entries by signing where indicated. Include your Title and Date of signing.
6. 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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