CMS 588 Form – Fill Out and Use This PDF

CMS 588 EFT PDF Details

The EFT Authorization Agreement is central to the modern Medicare payment ecosystem. It enables healthcare providers to enroll in Electronic Funds Transfer so Medicare payments go directly to designated bank accounts, reducing check delays and administrative burden.

Who Must Submit This Form

Any Medicare provider or supplier expecting payment must complete this agreement for new EFT enrollment, banking changes, or revalidation. You will need your IRS legal business name, National Provider Identifier (NPI), Tax Identification Number (TIN), and full bank details including routing and account numbers.

Required Information

• Reason for submission: new enrollment, change, or revalidation
• Legal business name and Medicare Identification Number
• Financial institution name, address, routing and account numbers
• Authorized official's signature, title, and contact email
• Supporting documents verifying bank account ownership

CMS requires prompt reporting of any banking or provider data changes to keep your EFT enrollment current.

Also see: CMS 855A enrollment form and standard EFT authorization form.