How do you enroll for the EFT service?

Providers can obtain an authorization form from their ActivHealthCare customer service representative or download a form from our website ActivHealthcare.com. It is located in the Forms section (from the left menu) of the website.

The form must be completed, uploaded to the Customer Service Center or faxed to (678) 736-8186. Note, the request form will ask for you to designate if the deposit will be made into a checking account or savings account. Please be sure to double check and make sure your have put the correct bank routing and account numbers on the form.

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