How to Complete and Submit the MassHealth EFT Enrollment Form (EFT-1)

The MassHealth EFT enrollment form, officially the EFT-1, sets up direct deposit of your MassHealth claim payments into a specific bank account. To complete it, download the form from the MassHealth EFT/ERA Enrollment page, fill in your provider identifiers and bank details, sign it (wet signature or a valid electronic signature with an uploaded handwritten image), attach a preprinted voided check or a qualifying bank letter, and mail the original to MassHealth Provider Enrollment and Credentialing, PO Box 278, Quincy, MA 02171-0278.¹ One boundary before you start: if you bill exclusively through a group practice and never submit claims under your own NPI, you can enroll as a “no pay” provider and skip the EFT form entirely.²

What You Need Before You Start

Every identifier on the EFT-1 has to match what MassHealth already has in your provider file. A mismatch is one of the fastest ways to get the form sent back. Pull these together first:

Your legal provider name as registered with the IRS.
Your Tax Identification Number, Employer Identification Number, or Social Security Number — the number you originally gave MassHealth when you enrolled as a provider.³
Your 10-digit National Provider Identifier.³
Your MassHealth Provider ID / Service Location, which the form calls the “Federal Program Agency Identifier.”³
Your bank’s nine-digit routing number.³
Your bank account number and whether it’s checking or savings.
A voided check, a bank letter, or in some cases a bank statement to verify the account.

What Counts as a Valid Voided Check or Bank Letter

This is where most EFT-1 submissions fail, so it’s worth getting right before you touch the form itself.

A voided check only qualifies if the provider name and address are preprinted on the check. Handwritten, stamped, or blank checks are not accepted, and bank deposit slips never substitute for a check.²

A bank letter must be on the bank’s letterhead and include the bank name, your provider name, the account number, and the routing number. If the letter shows a TIN, that TIN has to match the one on your EFT-1 and the one in your MassHealth provider file.² A bank statement that shows the bank name, provider name, and account number also works as an alternative.

Filling Out the EFT-1 Form

Download the EFT-1 from the MassHealth EFT/ERA Enrollment page on mass.gov.⁴ You can type into it on screen and then print, or print it blank and complete it by hand.

Page one opens with Reason for Submission. For a first-time setup, check “New enrollment.” Move to Provider Identifiers Information and enter your TIN or EIN, your NPI, and your MassHealth Provider ID. In Financial Institution Information, fill in the bank’s routing number, your account number, and the account type. In Submission Information, indicate whether you’re attaching a voided check, a bank letter, or a bank statement.¹

Page two is for your old bank account information. Leave it blank for a new enrollment; you only use it when you’re changing an existing EFT setup. At the bottom of the form, the certification section needs a signature and date from an authorized person, with their name and title printed clearly alongside.

Who Must Sign

The signature gets the closest look during processing, and the rule depends on who the provider is. Individual providers sign for themselves. A business or organization sends an authorized representative. Municipal providers must have the town treasurer sign.²

Two signature formats are accepted. A traditional wet signature on a printed form is always valid. Electronic signatures through DocuSign or Adobe Sign are also accepted, but only if the signer uploads an image of their actual handwritten signature. Typing your name in a signature font does not qualify.¹

Where to Mail It

Send the signed form and your account verification document to:

MassHealth Provider Enrollment and Credentialing
PO Box 278
Quincy, MA 02171-0278¹

For new EFT enrollments, MassHealth requires the hard copy with the original signature. Copies and faxes are not accepted.² Use a trackable mailing method, because the envelope carries sensitive banking information and a lost submission leaves you with no proof you sent it. Staple the voided check or bank letter securely to the form so they don’t separate in processing.

If the EFT-1 is part of a larger provider enrollment application, the whole package has to be returned within 14 days of receiving it. Applications not returned within that window are denied.²

Why Forms Get Rejected

Before you drop the envelope in the mail, run through the list of things MassHealth sends forms back for:

The voided check is blank, handwritten, stamped, or isn’t a check at all (bank deposit slips don’t count).²
The TIN on your bank letter doesn’t match the TIN on the form or in your MassHealth file.
The form is unsigned, signed by the wrong person, or signed with a typed-text “signature.”
The submission is a photocopy or a fax rather than the original.
You submitted a provider application without an EFT form and without a “no pay” designation.²

A rejection means starting the cycle again, so compare every field on the form against your MassHealth provider file before sealing the envelope.

Confirming Your Enrollment Went Through

Once the form has had time to process, confirm your EFT status by calling MassHealth at (800) 841-2900 (TDD/TTY: 711).¹ You can also email provider@masshealthquestions.com or fax inquiries to (617) 988-8974.⁵

Changing or Canceling Your Bank Information

Switching accounts or stopping direct deposit uses the same EFT-1 form. On page one, select “Change enrollment” to update banking information or “Cancel enrollment” to end electronic deposits.¹

If you’re changing accounts, fill in the old account information on page two. Skipping that step makes the request incomplete, and MassHealth won’t process it. Attach a new voided check or bank letter for the replacement account, and apply the same signature rules as a new enrollment.¹

Modifications and cancellations can be sent by fax to (617) 988-8974 or by mail to the same PO Box 278 address.¹ MassHealth also requires at least 14 days’ advance notice of any change in provider information, including banking details. Not giving that notice can be treated as a breach of your provider agreement under 130 CMR 450.223(B).⁶ Your EFT authorization stays in effect until MassHealth receives a written cancellation or a new form with updated information.

1
Commonwealth of Massachusetts. MassHealth EFT Enrollment/Modification Form
2
Mass.gov. Tips for Completing the Electronic Funds Transfer (EFT) Form
3
MassHealth. Electronic Funds Transfer Enrollment/Modification Form Instructions
4
MassHealth. EFT/ERA Enrollment
5
Mass.gov. Provider Online Service Center (POSC) Frequently Asked Questions
6
Mass.gov. Provider Enrollment and Credentialing FAQ