California
Statewide
Medi Cal
Last updated: 4/28/2026
EFT Electronic Fund Transfer Authorization
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Description
EFT ELECTRONIC FUND TRANSFER AUTHORIZATION. This form is used by healthcare providers to authorize the California Department of Health Care Services to deposit Medi-Cal payments directly into a designated bank account. This form collects provider identification details, including NPI or legacy number, tax ID information, and contact details, along with banking information such as routing and account numbers. Providers may also use the form to cancel an existing EFT authorization. The authorization remains in effect until formally terminated and requires an original signature and notarization. www.FormsWorkflow.com
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