What you need
- Electronic Funds Transfer Form. Providers must complete the authorized-signature (and date) field on the EFT form.
- Include the following documentation:
- Voided check.
- Bank letter that includes the bank name, provider name, bank account number, and routing number.
- Bank statement from the designated account.
Where do I mail my CMS 588?
Ensure to provide the reason why this CMS-588 EFT Form is being submitted….CMS-588 EFT Form Instructions and Helpful Hints.
| Regular Mail | Overnight Mail |
|---|---|
| WPS GHA Provider Enrollment P.O Box 8248 Madison, WI 53708-8248 | WPS GHA Provider Enrollment 1717 W. Broadway Madison, WI 53713 |
What is a Medicare revalidation?
Revalidations. Renewing Your Enrollment. You’re required to revalidate—or renew—your enrollment record periodically to maintain Medicare billing privileges. In general, providers and suppliers revalidate every five years but DMEPOS suppliers revalidate every three years.
How do I change my direct deposit for Medicare?
Recipients who are already receiving Social Security and or Supplemental Security Income benefits through direct deposit may change their account or bank information by callingPhone: (800) 772-1213. Representatives are available 1 (800) 325-0778. Please have your Social Security number available when you call.
How do I change my bank information with Medicare?
How do I change bank accounts or stop Medicare Easy Pay? There are 2 ways: Log into your secure Medicare account — Select “My Premiums” and then “See or change my Medicare Easy Pay” to complete a short, online form.
What is a CMS 588?
CMS 588. Form Title. Electronic Funds Transfer (EFT) Authorization Agreement.
What is eft form cms588?
CMS-588 Electronic funds transfer (EFT) The form must be complete, accurate, and include the original signature of the authorized/delegated official as well as the signature date. ( Note: when submitting through internet-based PECOS, the EFT form is available for electronic signature).
How long does it take to process a cms-588 form?
( Note: when submitting through internet-based PECOS, the EFT form is available for electronic signature). Mail the completed CMS-588 Form to: Complete and accurate applications will usually be processed within 45-60 days. You will receive a confirmation letter when all processing has been completed.
How do I fill out an eft authorization form?
The EFT authorization form must be signed and dated by the same Authorized Representative or a Delegated Official named on the CMS-855 Medicare enrollment application which the Medicare contractor has on file. Include a telephone number where the Authorized Representative or Delegated Official can be contacted.
