Electronic funds transfer (EFT): Revised Medicare enrollment application required

CMS revised the EFT authorization agreement (CMS-588). We will accept current and revised versions of the form through April 30. Effective May 1, you must use the revised form.

Form updates included, but not limited to:

• Correcting the page numbers
  

• Revising the form instructions for clarity
  

• Revising the titles of certain data elements for clarity
  

• Removing the Authorized / Delegated Official Title data element
  

• Adding a box for reporting the chain home office number
  

• Making the email address data element in Part V of the form optional