With the revised CMS 855S came the requirement that suppliers initially enrolling with the NSC or enrolling an additional location must submit the Authorization Agreement for Electronic Funds Transfer (CMS 588).
In August 2006, CMS revised the CMS 588 form. However, the NSC is still receiving the previous version. Suppliers should ensure the most up-to-date version is being submitted. Not submitting the current version will require the NSC to develop for this information, which will increase processing time.
The revised version of the
CMS 588 form is dated (08/06) EF 09/2006 and is available on the CMS Web site.
Suppliers should also ensure the proper contractor name is listed in Section V of the CMS 588 form. The DME MACs/DMERC are unable to accept or process this form without the correct name indicated. Therefore, the NSC is required to develop for this information, which leads to unnecessary delays in processing. Below are the names that should be listed in Section V of the CMS 588 form:
Note: Due to the transition of the Region C DMERC to the Jurisdiction C DME MAC, Palmetto GBA will continue to accept the CMS 588 with it listed as the contractor unit May 11, 2007. After that date, suppliers required to submit the CMS 588 form to the NSC, should list Cigna Government Services as the contractor in Section V.
Jurisdiction A: NHIC, Corp.
Jurisdiction B: National Government Services
Region C DMERC: Palmetto GBA (not PGBA)
Jurisdiction D: Noridian Administrative Services
If you have any questions regarding this requirement or about the CMS 588 form, please
contact the NSC.