Electronic Funds Transfer (EFT) Agreement CMS–588

Important Information

The Centers for Medicare & Medicaid Services (CMS) mandated that as of April 2006, all new Medicare enrollees must receive payments electronically through Electronic Funds Transfer (EFT). All existing providers are required to begin EFT when submitting changes to their existing enrollment information. Once providers are enrolled in EFT, the EFT agreement cannot be terminated and providers cannot request to receive paper checks. Providers can update or change bank information as necessary

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CMS 588 Form - EFT Authorization Agreement

Please visit our Forms web page to access the CMS-588 form.

To avoid delays in processing your application, please consider the following:

  • Ensure that all information is legible and accurate.
  • If you have not revalidated with an 855A application within the last five years you will be required to do so at this time. If you are unsure if a revalidation will be needed or would like more information you may contact Provider Enrollment at (866) 734-9444 and request to speak with the Provider Enrollment department.
  • Submit the most current CMS 588 Form. The version number is located in the lower left corner of the agreement and should read: Form CMS-588 (05/10).
  • Mail your application with the original signature (no facsimile or photocopied signatures can be accepted) to WPS at the address listed below:

Regular Mail

WPS Medicare Part A
Financial Unit
P.O. Box 1602
Omaha, NE 68101

Overnight Mail

WPS Medicare Part A
Financial Unit
3333 Farnam St.
Omaha, NE 68131

Helpful Hints to Complete the CMS-588 Form

Part II-Provider or Supplier Information

  • Ensure that the Tax ID, Medicare ID, and NPI numbers are listed correctly.
  • If you are submitting applications for subunits, please fill out a separate CMS-588 for each unit as well as the main facility.

Part III-Depository Information

  • Include a voided check or deposit slip that matches the information given on the application.
  • If you are unable to supply a voided negotiable item, please include a letter from the financial institution on their letterhead that cites the provider name, account, and routing number that matches the information listed on your application.

Part IV-Contact Person

  • Cite the person who should be contacted in the case of an error on the application or if additional information is needed.
  • This person does not need to be the signer.
  • Please include a fax number and an e-mail address.

Part V-Authorization

  • The EFT authorization form must be signed and dated by the same Authorized Representative or a Delegated Official named on the CMS-855 Medicare enrollment application that WPS has on file.

Page Last Updated: Tuesday, 15-Nov-2011 09:05:51 CST