Loading
Get Cms-588 2013
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the CMS-588 online
Filling out the CMS-588 form is essential for healthcare providers seeking to authorize electronic funds transfers for Medicare payments. This guide will walk you through each step of the process to ensure accurate and complete submission.
Follow the steps to successfully complete your CMS-588 form.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In Part I, select your reason for submission by checking the appropriate box: New EFT enrollment, change in current EFT enrollment, or cancellation of EFT enrollment. If applicable, attach a letter authorizing EFT payment to the home office of the chain organization.
- Complete Part II with Account Holder Information. Enter the legal business name of the provider or supplier as reported to the IRS. If there is a chain organization, provide its name. Fill out the practice location address, including street, city, state, and zip code. Provide the Tax Identification Number and any Medicare identification number if issued.
- For Part III, fill out Financial Institution Information. Enter the institution's name, address, city, state, and zip code. Provide the institution's contact information including telephone number, contact person's name, routing number, and your account number with the financial institution.
- In Part IV, enter the contact person's name and title, along with their telephone number and email address. This person should be able to answer questions regarding the form.
- In Part V, authorize the agreement by signing and dating the form. Ensure the form is signed with an original signature in black or blue ink. Contact information for the authorized official should also be included.
- Finally, review your completed form for accuracy. Save changes or download the form as needed. Make sure to submit the signed form to the appropriate Medicare contractor for processing.
Complete your CMS-588 form online to ensure smooth and efficient processing of your electronic funds transfer.
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Filling out an EFT authorization form involves entering your personal information, bank details, and the type of payments you wish to authorize. Always double-check your information to prevent errors. After you sign the form, submit it according to the guidelines provided by your institution or service provider.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.