Part A Electronic Funds Transfer (EFT) Enrollment Packet

Medicare Part A providers may receive payment by electronic funds transfer (EFT). The Authorization Agreement for Electronic Funds Transfer Form CMS 588 (PDF, 106 KB) must be completed to receive payment by EFT or to add, change or terminate a current EFT agreement.

When adding or changing an EFT agreement, you must send along with the CMS 588 form a preprinted voided check or a letter from the bank that contains the name of the provider and banking information. If payment will be mailed to an account maintained by a Home Office of a Chain Organization, a letter authorizing Palmetto GBA to make payment into the Home Office account must be attached. Please refer to the CMS 588 Instructions for specifics.

Please send the completed CMS 588 form and required documentation to the following address:

Palmetto GBA
Part A Provider Enrollment, AG-331
2300 Springdale Drive, Building One
Camden, SC 29020

Palmetto GBA will review the EFT forms to ensure all required documentation is present and the EFT form has been signed by the 'authorized representative or delegated official.' For questions on EFT, please contact the Part A Provider Contact Center (PCC) at 855-696-0705.

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Provider Contact Center: 855-696-0705

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