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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
PART III: Financial Institution Information Complete all fields
  • Routing number is nine digits long
  • Entire account number including applicable leading zeros
PART IV: Contact Information Complete all fields
  • Enter title of contact person
PART V: 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: 12/1/17

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National Government Services, Inc.
P.O. Box 6475 | Indianapolis, IN 46206-6475

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National Government Services, Inc.
P.O. Box 7149 | Indianapolis, IN 46207-7149

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