WebForm CMS-588 with initial enrollment applications. 2. CMS-460 – Medicare Participating Physician or Supplier Agreement . This agreement establishes that the Medicare provider/supplier accepts assignment of the Medicare Part B payment for all services for which the participant is eligible to accept WebForm CMS-588 Rev 12/2024 This is the person we will contact for any questions regarding this EFT. NOTE The account name to which EFT payments will be paid is to the name submitted on Part II of this form. Enter the financial institution s street address. The valid OMB control number for this information collection is 0938-0626.
CMS 588 CMS - Centers for Medicare & Medicaid Services
WebMar 23, 2016 · Contact us about Form CMS-588 Electronic Funds Transfer (EFT) (866) 518-3285. 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F. [email protected]. Do not submit PHI/PII through email. Questions about Payments, Fee Schedules, and Incentive Programs (866) 234-7331. WebAlong with the Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) form, a voided check or signed bank letterhead is required to verify your account and routing number. The voided check must be a true voided check. Starter checks are not acceptable. If you choose to send in a bank letterhead, it must consist of the following: name ... robert swanson company
Provider Enrollment and Certification Enrollment Applications - HHS.gov
WebAug 31, 2024 · The following forms can be used for initial enrollment, revalidations, changes in status, and voluntary termination: CMS-855A for Institutional Providers. CMS-855B for … WebMar 24, 2016 · Contact us about Form CMS-588 Electronic Funds Transfer (EFT) (866) 518-3285. 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F. [email protected]. Do not submit PHI/PII through email. Questions about Payments, Fee Schedules, and Incentive Programs (866) 234-7331. WebFeb 8, 2016 · Contact us about Form CMS-588 Electronic Funds Transfer (EFT) (866) 518-3285. 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F. [email protected]. Do not submit PHI/PII through email. Questions about Payments, Fee Schedules, and Incentive Programs (866) 234-7331. robert swartz attorney