Common Contracts

This EFT Authorization Agreement must be fully completed, signed and returned via U.S. Mail or fax to: Blue Cross and Blue Shield of Texas (BCBSTX)

Eft Authorization Agreement • February 21st, 2012 • Texas

• Contract Type
  Eft Authorization Agreement
• Filed
  February 21st, 2012
• Jurisdiction
  Texas

This enrollment form will be used to activate EFT for both BCBSTX commercial payments and BCBSTX Medicaid payments (if you are a BCBSTX Medicaid network provider).