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Last Modified: 3/21/2018 Location: FL, PR, USVI Business: Part A, Part B

Submission of an EFT Agreement

Q: As an established provider with Medicare who receives paper checks, does an electronic funds transfer (EFT) agreement need to be included when I submit a change to my provider enrollment file?
A: Yes, unless you are reassigning all of your Medicare benefits to your employer or a clinic/group practice.
First Coast Service Options Inc. (First Coast) requires the Electronic Funds Transfer (EFT) authorization agreement (CMS-588) form if you are submitting an initial provider enrollment application or a change to an existing Medicare provider file that has not previously been set up for EFT.
When submitting the EFT authorization agreement, be sure to use the CMS-588 (09/13) version external pdf file of the form. The form must be complete, accurate, and include the original signature of the authorized/delegated official, as well as the signature date. Remember to include a confirmation of the account information on bank letterhead and/or a voided check. With the EFT authorization, Medicare can send payments directly to your financial institution whether claims are filed electronically or on paper.
Note: Please check with your bank for the proper number to report as the routing number on your EFT form. First Coast has determined that some banks may not use the routing number located at the bottom of your pre-printed check or deposit ticket for direct deposits but may use the automated clearing house (ACH) number located elsewhere on the check or deposit ticket.
An organization or facility does not need to submit an EFT for each of its members, only for the legal entity.
Source: The Centers for Medicare & Medicaid Services (CMS) internet-only manual (IOM) publication 100-08, chapter 15 external pdf file
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First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.