The CMS 588 Form
DMEPOS suppliers initially enrolling or submitting an application for a new location are required to complete and submit the current Authorization Agreement for Electronic Funds Transfer (EFT) Agreement (CMS 588).
Note: Suppliers revalidating should submit the necessary CMS 588 form(s) if not already enrolled to receive payments through EFT.
The form must have the original signature of an authorized or delegated official listed on the CMS 855S. Also, suppliers must include one of the following documents to verify the account information:
- A voided check
- Preprinted deposit slip
- Confirmation of account information on bank letterhead for verification of the account number
The NSC's role is to ensure the agreement is signed properly. Once verified, the NSC will send the agreements to the DME MACs for processing.
The CMS 588 form can be found on the CMS Web site.
Last Updated: 05/08/2006