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CMS 588 EFT (1/17) Completion Tips for Sole Proprietors, Sole Owners, Clinic/Groups, Organizations and Suppliers

NOTE: Providers reassigning all benefits to a group, do not need to complete the CMS 588.

Section General Guidelines
Part I:
Reason for Submission
Mark all that apply
  • New or Change EFT information - attach a copy of a voided check or bank confirmation letter
  • Chain Organizations - attach letter authorizing EFT payment to the Chain Home Office
Part II:
Account Holder Information

Complete all fields that apply
  • Providers/Suppliers/IPP billers must report the legal business name provided on the IRS document
  • Sole proprietors using EIN indicate EIN for designated TIN
Financial Institution Information
Complete all fields
  • Routing number is 9 digits long
  • Entire account number including applicable leading zeros

Contact Information
Complete all fields
  • Enter title of contact person

Authorization (Signature Line)
Complete all fields
  • Sign and date by sole proprietor or authorized/delegated official of a group
  • Enter title of authorized/delegated official

Reminder:  To avoid possible hold on payments or deactivation of billing privileges, respond timely to additional information request for the incomplete/inaccurate CMS 588 form.

Last Modified: 8/14/17

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J6 Mailing Address:

National Government Services, Inc.

P.O. Box 6474 | Indianapolis, IN 46206-6474

JK Mailing Address:

National Government Services, Inc.

P.O. Box 7149 | Indianapolis, IN 46207-7149

Contact Enrollment:

J6: 855-834-5596

JK: 855-593-8047

Available by phone Monday-Friday*
JK: 8:00 a.m.-4:00 p.m. ET
J6: 8:00 a.m.-4:00 p.m. CT
J6: 9:00 a.m.-5:00 p.m. ET

*Closed for training on the 2nd and 4th Friday of the month
12:00 p.m.-4:00 p.m. ET
11:00 a.m.-3:00 p.m. CT

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