Financial Area - Electronic Funds Transfer Information
EFT Process and Contacts
If your organization prefers to receive Medicare payments via Electronic Funds Transfer, complete Form CMS-588 and include it with your provider enrollment application. The form must be submitted with an original signature (no faxes or photocopies) of an authorized or delegated official, identified on the Form CMS-855A. In a letter, signed by the authorized or delegated official, list the signers of the bank account and explain their relationship to your organization. Please specify whether or not the signers are associates of a billing agency.
Here is a link to CMS' website for the newly revised CMS Form 588 (revised September 2006):
For all CMS Forms on CMS' website, click here:
http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp 
The form is:
For questions regarding this process, please contact our Medicare Financial Area using our toll free number (866) 734-1522.
You may contact any of the following individuals:
Stepheni Bomer - extension 2566
Julie Rosenbaugh- extension 4396
Page Last Updated: Thursday, 13-Nov-2008 10:07:10 CST
