In order to ensure a smooth transition and no disruption to your electronic payments, please make sure that the person(s) responsible for receiving your Medicare payments is advised of this notice and the action required.

In accordance with the Centers for Medicare & Medicaid Services (CMS) and U.S. Treasury Department rules for electronic transfer of funds (31 Code of Federal Regulations (CFR), Part 210.6), Medicare Part A and Medicare Part B providers in Connecticut and New York with existing Electronic Funds Transfer (EFT) agreements with the current fee-for-service contractors are required to submit an updated CMS-588 authorization agreement form for EFT to National Government Services. Providers who fail to submit an EFT agreement to National Government Services by the dates below may experience possible payment delays and/or disruption in electronic claim payments.

As the EFT agreement, form CMS-588, is a contract between the payor and payee, we are unable to transfer your agreement with your current Medicare contractor. Banking regulations require us to have a new agreement from each provider to authorize National Government Services specifically to make electronic payments to your bank account. To obtain a copy of the CMS 588 EFT Agreement, please visit the National Government Services Web site at
http://www.ngsmedicare.com/ngsmedicare/PartB/J13/588EFTFormWithNGSJ13.pdf.

In order to ensure that your agreement is processed promptly, please complete the EFT agreement with your current banking information and forward along with a copy of a voided check to the following address:

National Government Services
Provider Enrollment - EFT
P.O. Box 4792
Syracuse, NY 13221-4792

Due to the volume of applications being processed, we encourage you to submit your application as soon as possible. In order to ensure there is no disruption to payments, please submit a new agreement by the date indicated on the chart below.

CMS-588 Instructions

Complete Form CMS-588, Electronic Funds Transfer (EFT) Authorization Agreement. The “Instructions for Completing the EFT Authorization Agreement,” page 3 of the CMS–588, provides specific instructions for completion of the CMS-588. Submission of an incomplete CMS-588 may result in disruption in the provider’s electronic claim payments. The following are additional tips for completing the CMS-588:

• CMS-588 Part I – Check the New EFT Authorization box as the reason for submission.

CMS-588 Part V – List National Government Services as the authorized contractor. Ensure your organization’s authorized or delegated official, currently on file with your legacy Medicare contractor, signs form CMS-588. Note: The CMS-588 form located on the National Government Services Web site at http://www.ngsmedicare.com/ngsmedicare/PartB/J13/588EFTFormWithNGSJ13.pdf is preprinted with National Government Services as the contractor in Section V.

Additional blank forms can be downloaded from the CMS Web site at http://www.cms.hhs.gov/cmsforms/downloads/CMS588.pdf.

• An authorized official means an appointed official (e.g., chief executive officer, chief financial officer, general partner, chairman of the board, or direct owner) to whom the organization has granted the legal authority to enroll it in the Medicare program, make changes or updates to the organization’s status in the Medicare program, and commit the organization to fully abide by the statutes, regulations and program instructions of the Medicare program.
• A delegated official means an individual who is delegated by an authorized official the authority to report changes and updates to the provider’s enrollment record. A delegated official must be an individual with an “ownership or control interest” in (as that term is defined in Section 1124(a)(3) of the Social Security Act) or be a W-2 managing employee of the provider. Delegated officials may not delegate their authority to any other individuals.

Provider Support

• The CMS-588 must have an original signature and date.



• Include a voided check, voided deposit slip or copy of a letter of verification from your financial institution. This letter must verify the account and Automated Clearing House (ACH) transit number provided on the CMS-588 and be signed by an employee of the bank. The legal business name listed on the voided check, deposit slip or letter must be an exact match to the legal business name listed on the CMS-588.

The requested CMS-588 form is for the continuation of existing EFT agreements. National Government Services cannot accept EFT changes (i.e., changes in bank routing information or authorized representative changes) prior to the planned implementation date. Providers who wish to change their established EFT information or change their current payment status must submit those changes to their legacy Medicare contractor.

For questions regarding the EFT agreements, please contact the National Government Services Provider Customer Care Contact Center at 866-837-0241.