Do I have to submit an authorization agreement for electronic funds transfer (CMS 588) to the NSC?

DMEPOS suppliers are required to submit the EFT agreement with the application form when initially enrolling or submitting an application for a new location. Note: For changes to a current EFT agreement, please contact your DME MAC.

When completing the form, suppliers should ensure the form has the signature of the authorized or delegated official. Further, suppliers must include with each form submitted a voided check or confirmation of account information on bank letterhead for verification of the account number.

The NSC will then send the agreement to the appropriate DME MAC for processing.

The CMS 588 (PDF) form may be downloaded from the CMS website.

Last Updated: 09/09/2022