Electronic Funds Transfer (EFT) - JF Part B
Electronic Funds Transfer (EFT)
Electronic Funds Transfer (EFT) deposits your Medicare payments directly into your bank account. CMS requires that all providers that are enrolling in Medicare Part B, revalidating, or making any changes to their file, must use EFT.
Complete and submit the Electronic Funds Transfer Authorization Agreement - CMS 588.
To correctly complete and submit this application, view the Enrollment on Demand Tutorials and related tips below.
Provider or authorized/delegated official must sign and date application
- Office staff signature not acceptable
- Signature must be original (cannot be a copy or stamped signature)
Check designated box to right of Tax ID Number field on application
- Sole Proprietors must list his/her Social Security Number (SSN) and check SSN box as instructed in application
Groups submit this application and indicates group Provider Transaction Access Number (PTAN) in Medicare Identification Number field
- Groups should not submit this application for each of its members
In addition to a completed application, provider must include a voided check or letter from bank
- This will verify type of account, routing number, and bank account number
To change accounts or banks, fill out a new CMS-588 application, using the new account information, by following our Enrollment on Demand Tutorials.
- Complete form and return it with an original signature of provider or authorized/delegated official for that organization
- Include a voided check or letter of verification from your financial institution. Letter must be on bank letterhead, signed by a bank official and must include verification of following: type of account (checking or savings), name on account, account number and ACH routing number
- In Account Holder Information section, indicate provider Medicare (Noridian) Part B PTAN in Medicare Identification Number field
- If submitting a Change of Ownership, check that option in Part I
- Be sure to check designated box above where Tax ID Number is listed. Note: Sole Proprietors will always list his/her SSN and check SSN box
Last Updated Tue, 14 Aug 2018 11:11:05 +0000