Completing the Medicare Enrollment Application - EFT Authorization Agreement (CMS-588) application

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Home ► PE Tips and tutorials ► Completing the Medicare Enrollment Application - EFT Authorization Agreement (CMS-588) application

Last Modified: 11/20/2024 Location: FL, PR, USVI Business: Part A, Part B

Completing the Medicare Enrollment Application – Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) application

The Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588 external pdf file

) application is used to have your Medicare payments deposited directly into your bank account. It eliminates paperwork and saves time by reducing routine banking.

Note: Non-participating providers or suppliers are also required to submit an EFT form as they may receive a direct Medicare payment in the event the non-participating provider or supplier chooses to accept the Medicare assignment for services rendered. Based on the statuses, all payments must be made via EFT.

In April 2022, the PECOS user interface was updated with additional Part A EFT functionality. As a result, providers submitting the new Part A EFT information may see an extended prenote period prior to the EFT becoming effective.

The chart below is designed to provide additional instructions on completing the enrollment application. Please make sure to follow the guidelines listed on the application.

Note: Once you complete the application, you can mail the application to us. (Effective October 3, 2024, the CMS-588 EFT forms will no longer be accepted via upload on the Provider Enrollment Gateway tool.)

Section of form	Helpful hints
Part I: Reason for submission	If selecting new EFT enrollment, you must select individual or group: • Individuals who own a sole owner group must select group and provide all group information If you are authorizing EFT payments to the home office of a chain organization of which you are a member, you must attach a letter: • Letter must be signed by an authorized official of the provider of service and an authorized official of the chain home office
Part II: Account holder information	Entities: • Legal business name on application, enrollment file, and voided check/bank letterhead must match what is reported to the IRS Individuals: • First and last name on application, enrollment file, and voided check or bank letterhead must match what is reported to the social security administration Bank accounts cannot be jointly held If you have a chain home office, make sure to supply chain organization name and office number Note: Do not include PO Boxes
Part III: Financial institution information	Account and routing number must match the voided check or bank letterhead exactly Type of account is required Note: Do not include PO Boxes
Part IV: Contact person	Enter the contact information for the individual who can answer questions about the information submitted on the application
Part V: Authorization	The EFT authorization form must be signed and dated by the same authorized representative, or delegated official named on the CMS-855/20134 Medicare enrollment application which the Medicare contractor has on file. Signatures must be handwritten or an eligible digital signature (e.g., DocuSign, AdobeSign), as well as dated. Stamped signatures will not be accepted.
Additional guidance	Depending on the reason for submission, we may need phone verification before approving the application. An entity does not need to submit an EFT for each of its members. Only the entity submits the form. A voided check or bank letterhead is required in the provider’s/supplier’s/entity’s legal business name only: • Starter checks and deposit slips are not acceptable. • Bank letterhead must list name of the account, routing number, account number, account type, bank officer's name, and signature.

Frequently asked questions (FAQs)

1. Is the EFT Authorization Agreement (CMS-588) form required?

Per CMS regulations, all provider or suppliers who plan to bill for Medicare services are required to receive payment electronically. If you are an individual, organization or Part A provider who plans to bill for Medicare services, this form must be included in your enrollment package. This form enables Medicare payments to directly deposit into your bank account.

2. What supporting documentation is needed?

Along with the EFT Authorization Agreement (CMS-588) form, a voided check or signed bank letterhead is required to verify your account and routing number. The voided check must be a true voided check. Starter checks are not acceptable. If you choose to send in a bank letterhead, it must consist of the following: name on account, routing number, account number, account type, bank officer's name, and signature.

Note: For an organization or Part A provider, the legal business name on the voided check or bank letterhead must match what is reported to the IRS and enrollment file exactly. For an individual, the first and last name must match what is reported to the Social Security Administration (SSA) and enrollment file exactly.

Bank accounts cannot be jointly held.

3. If I have a sole owner group, do I list my individual information or my group's information?

A sole owner group is defined as a group owned by one person. If the EFT form is for a sole owner group, you must supply the group's information. The legal business name, employer identification number (EIN), PTAN (if issued), and NPI would be the group's information. The supporting documentation (voided check or bank letterhead) must also be in the legal business name of the group.

4. Who signs this form in part V?

For an individual, the provider supplies his or her name, telephone number, official title, e-mail address, signature, and date. For an organization or Part A provider, the authorized or delegated official signs the form. The individual must already be designated as an authorized or delegated official for the entity in the enrollment file. If he or she is not, please submit a change of information application along with the EFT Authorization Agreement (CMS-588) form.

5. We changed banking institutions. How do we make that change for EFT?

To change your current EFT information, please complete an EFT Authorization Agreement (CMS-588) form external pdf file

. Under section 1, check the box for change to current EFT enrollment.

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