Financial Area – Electronic Funds Transfer Information
EFT Changes & Requirements
In accordance with the Program Integrity Manual, Section 10.4 (Rev. 41, 05-23-03), CMS now views a change to the EFT form (Form CMS-588) as a change to the pay to" address. Any time an enrolled provider notifies WPS s financial department that they are changing bank accounts for their EFT, the provider enrollment area will check to see if there is a competed provider enrollment form (Form CMS-855A) on file.
If the enrolled provider does have a completed provider enrollment form (Form CMS-855A) on file, WPS will verify that the signature on the newly submitted EFT form (Form CMS-588) matches the signature on the provider enrollment form (Form CMS-855A).
If the enrolled provider does not have a completed provider enrollment form (Form CMS 855A) on file with WPS - Provider Enrollment Area, they must complete an entire Form CMS-855A. The signature on the EFT form (Form CMS-588) must match the signature on the provider enrollment form (Form CMS-855A).
The address to send the completed Form CMS-855A to:
WPS
Medicare Audit and Reimbursement
Attn: Provider Enrollment Supervisor
P.O. Box 1604
Omaha, NE 68101
For overnight mail use:
WPS
Medicare Audit and Reimbursement - LL2
Attn: Provider Enrollment Supervisor
Mutual of Omaha Plaza
Omaha, NE 68175
EFT Process and Contacts
If your organization prefers to receive Medicare payments via Electronic Funds Transfer, complete Form CMS-588 and include it with your provider enrollment application. The form must be submitted with an original signature (no faxes or photocopies) of an authorized or delegated official, identified on the Form CMS-855A. In a letter, signed by the authorized or delegated official, list the signers of the bank account and explain their relationship to your organization. Please specify whether or not the signers are associates of a billing agency.
Here is a link to CMS' website for the newly revised CMS Form 588 (revised September 2006):
For all CMS Forms on CMS' website, click here:
http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp
The form is:
For questions regarding this process, please contact our Medicare Financial Area using our toll free number (866) 734-1522.
You may contact any of the following individuals:
Elizabeth Peet - extension 4396
Scott Gillispie - extension 6430
Stephanie Lauritsen - extension 2566
Terri Musgrave - extension 4920
Page Last Updated: Tuesday, 15-Jul-2008 10:37:31 CDT
