Form cms 588

Form cms 588

Download Form cms 588




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Address Line 1 (Street Name and Number). Address Line 2 (Suite, Room, etc.) City/Town. State. ZIP Code + 4. E-mail Address. FORM CMS-588 (08/06) EF 07/

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Dec 19, 2013 - Instructions for completing the CMS 588 EFT form. We cannot alter CMS' instructions, but we received permission to add additional This Authorization Agreement for Electronic Funds Transfers is used to submit necessary information for the initiation of electronic funds transfers of Medicare WPS has received some questions regarding if and when a provider will be required to submit more than one CMS-588 form. The general rule to follow is that a

Forms · IHS/Urban/Tribal Providers JH Home, ?, Enrollment, ?, Enrollment Form: Electronic Funds Transfer (EFT) Authorization Agreement (CMS-588) Form CMS-588 (09/13). 1. DEPARTMENT OF HEALTH AND HUMAN SERVICES. CENTERS FOR MEDICARE & MEDICAID SERVICES. Form Approved. Dec 19, 2013 - Providers are required to signup for electronic funds transfer (EFT) using a CMS-588 EFT form upon initial enrollment in the Medicare programForm #: CMS 588; Form Title: Electronic Funds Transfer (EFT) Authorization Agreement; Revision Date: 2013-09-01; O.M.B. #: 0938-0626; O.M.B. Expiration CMS Form CMS 588 - Electronic Funds Transfer (EFT) Authorization Agreement. 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 (09/13).

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