Electronic Funds Transfer

Electronic Funds Transfer (EFT) Agreement

Electronic Funds Transfer (EFT) allows Medicare payments to be received electronically by the provider of Medicare services. 

Recently we noticed an increase in the number of EFT forms (CMS 588) being sent in that are incomplete.  Below are the most common reasons why we cannot complete the enrollment into EFT and what to do to avoid sending an incomplete EFT:

Commonly Missed Items upon Submission for EFT Agreement

• EFT form not signed by the provider, or authorized/delegated official - to avoid this, please make sure that the person signing the CMS 588 form is the person who signed  section 15 or 16 of the CMS 855 application.

• Information on EFT form not on Medicare file (i.e. EIN) and/or or their PIN number is inactive - to avoid this please send us a CMS 855 application to update their Medicare file.

• Failure to attach an original voided check, pre-printed deposit slip, or confirmation of account number and routing number on the bank letterhead

• Information on attached voided check/deposit slip is not accurate - to avoid this please make sure that the pre-printed check or deposit slip has your legal business name or name of provider and the information is what you had sent in your application.

• The attached bank letter does not contain both the routing number and account number.

Please make sure to follow the guidelines carefully prior to submitting your EFT agreement form to avoid unnecessary delays.

Effective November 1, 2007, the EFT Agreement version 08/2006 EF 07/2007 is the only version acceptable. The EFT form is available on the CMS site at: http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp

Once you open the link, you must select the following options to download the EFT form:

• Select: “Show Only”
• Select: “Show  Only Items Containing The Following Word”
• Enter “EFT” and select “Show Items”.

Include an original voided blank check or deposit slip. Once your application is processed, Medicare payments will be made directly to your financial institution through EFT.

Please visit our Electronic Data Interchange (EDI) Web site to obtain further information on how to enroll in the NHIC EDI system in order to bill Medicare electronically.

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 Mailing Address

Mail your completed EFT agreement form for ME, MA, NH, RI, or VT to:

Provider Enrollment
P.O. Box 3434
Hingham, MA 02044

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05/01/2009