Nebraska Medicaid Program

Electronic Data Interchange (EDI)

Electronic Funds Transfer (EFT)

Avoid mailing delays!
Have your Medicaid payments deposited directly in your bank.

To get started, print the EFT enrollment form below. Mail or fax the completed form to:

Department of Health and Human Services
ATTN: Provider Enrollment
P.O. Box 95026
Lincoln, NE 68509-5026
Fax: 402-742-2373

Direct deposit of your Medicaid payment will begin approximately 10 days after we receive your form.

EFT ENROLLMENT FORM

State of Nebraska ACH Enrollment Form

Frequently Asked Questions about EFT

How do I change from paper check to direct deposit?

It’s easy! Print the enrollment form. Work with your financial institution to complete the form. Mail or fax the completed form. Direct deposit of your Medicaid payment will begin approximately 10 days after we receive your form.

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How long will it take before direct deposit begins?

Direct deposit of your Medicaid payment will begin approximately 10 days after we receive your form.

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What if I change banks?

Complete a new EFT Enrollment Form. Check the box indicating “Change” at the top of the form.

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What if I close my bank account?

Fax (402-742-2373) or mail written notification. Be sure to include your 11-digit Medicaid Provider Identification Number.

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Will my Remittance Advice change?

Direct deposit of your payment does not change the way your Medicaid Remittance Advice is sent.

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All forms available on this page are in PDF format and require the use of Adobe Acrobat Reader which can be downloaded for free from Adobe Acrobat Systems, Inc.