Electronic Funds Transfer allows the transfer of Medicare payments directly from Medicare to a provider’s bank account.
Enrollment Overview
The following is a high level overview of the EFT Enrollment Process:
- EFT applications are received, prepped and imaged
- The applications are entered into our DME EFT Database, analyzed/verified for accuracy
- A valid application is then entered in the VMS system for pre-note testing.
- Once the testing is completed (typically a 2 week process) the file goes into production mode.
- For those applications that failed the pre-note testing, a validation process is initiated including contact with the supplier to either verify or correct.
- Incomplete applications are entered in the DME EFT Data Base and a letter is sent to the supplier requesting the missing information.
- The normal processing time for a completely valid EFT application is 30 days.
- Incomplete/incorrect applications will take longer than 30 days to finalize, based on how quickly the missing information is provided and processed.
Should you have a question about the status of your EFT enrollment application, please call 866-563-0049.
Enrollment Information
In order to receive claims payments electronically, enroll in EFT by following the instructions below:
Instructions
IMPORTANT NOTE: To minimize unnecessary delays in the processing of your application, please include both your NPI and your Legacy (NSC) number in the appropriate fields.
- Complete the authorization agreement by clicking on the link: http://cms.hhs.gov/cmsforms/downloads/CMS588.pdf
 and downloading a copy of the Form.
- Attach a blank voided check or bank deposit slip to the signed EFT agreement.
- Retain one copy for your files.
- Mail the signed authorization agreement, along with the voided check to:
EDI/EFT DME Enrollments Forms
PO Box 9185
Hingham, MA 02043-9185
CMS-588 Checklist
Download the below checklist as a PDF by clicking on the link: CMS-588 Checklist (20KB)
Part I - Reason for Submission |
Reason (checked reason for submitting form) | [ ] |
|
Part II - Provider / Supplier Information |
Supplier Name | [ ] |
Supplier Legal Name | [ ] |
Chain Organization Name | [ ] |
Home Office Legal Business Name | [ ] |
EIN or SSN Number | [ ] |
Medicare ID Number
(DME PTAN / Supplier Number issued by the National Supplier Clearinghouse) | [ ] |
NPI Number | [ ] |
|
Part III - Depository / Banking Information |
Financial Institution Name | [ ] |
Address, City, State and Zip code | [ ] |
Routing Transit Number | [ ] |
Account Number | [ ] |
An original voided check, deposit slip or bank letter enclosed
(Make sure banking information on form matches documentation submitted) | [ ] |
|
Part IV - Contact Information |
Name | [ ] |
Telephone / Fax Number | [ ] |
Address, City, State and Zip code | [ ] |
Email (optional) | [ ] |
|
Part V - Authorization |
Added NHIC Corp to blank line in paragraph | [ ] |
|
Signature - Signed by an authorized / delegated official |
Printed Name and Title (legal name) | [ ] |
Signed (original signature only) | [ ] |
|
Don't forget to enclose an original voided check, deposit slip or bank letter
This checklist is to assist with completing the CMS-588 form.
It does not need to be mailed with the application. |
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02/19/2010
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