Last Modified: 6/22/2017
Location: FL, PR, USVI
Business: Part A, Part B
CMS-588 Electronic funds transfer (EFT)
EFT is a form of direct deposit that allows the transfer of Medicare payments directly from a Medicare contractor’s bank to a provider’s bank account. CMS requires that all providers enrolling or changing existing enrollment information must use EFT.
The EFT authorization agreement form may be downloaded from the CMS website https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/CMS588.pdf 
. The form must be complete, accurate, and include the original signature of the authorized/delegated official as well as the signature date.
. The form must be complete, accurate, and include the original signature of the authorized/delegated official as well as the signature date.Medicare administrative contractors (MACs) will continue to accept the 09/13 version of the CMS-588 through December 31, 2017. After December 31, 2017, the MACs will return any newly submitted 09/13 versions of the CMS-588 applications. The provider/supplier must then submit a current version (01/17) of the CMS-588.
Mailing instructions
Mail the completed CMS-588 Form to:
First Coast Service Options
PO Box 44021
Jacksonville Florida 32231-4021
Check the status of your application with the Enrollment status lookup
Complete and accurate applications will usually be processed within 45-60 days. You will receive a confirmation letter when all processing has been completed.
To check the status of your EFT application or any other provider enrollment application, you may use First Coast’s Enrollment status lookup. This versatile application allows you to check the status of your enrollment in the Medicare program in two ways. You may search for all pending applications by entering your National Provider Identifier (NPI) and provider transaction access number (PTAN), or you may check the status of a specific application by entering the 12-digit correspondence control number (CCN) and three-digit record number (listed in your acknowledgement letter).
If you have a general question about EFT agreements, you may call the appropriate number below:
Florida
• Medicare Provider Enrollment Part A & B -- (888) 845-8614
• Medicare Part A application -- (888) 664-4112
• Medicare Part B application -- (866) 454-9007
Puerto Rico
• Medicare Provider Enrollment Part A & B -- (888) 845-8614
• Medicare Part A application -- (877) 908-8433
• Medicare Part B application -- (877) 715-1921
U.S. Virgin Islands
• Medicare Provider Enrollment Part A & B -– (888) 845-8614
• Medicare Part A application -- (888) 664-4112
• Medicare Part B application -- (866) 454-9007
A group does not need to submit an EFT form for each of its members. Only the group submits the form and indicates the group PIN and NPI if issued.
For more information, refer to our EFT tutorial 
.
.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.
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