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In Part I, select your reason for submission by checking the appropriate box: either 'New EFT Authorization' or 'Revision to Current Authorization'. If applicable, attach a letter authorizing EFT payment to the Chain Home Office.
Proceed to Part II and fill in your provider or supplier information. Ensure that you enter the legal business name, tax identification number, and National Provider Identifier (NPI) accurately.
In Part III, provide depository information. Enter the financial institution's name, address, and contact details. Don’t forget to include the routing transit number and account number.
Complete Part IV by entering the contact person's details responsible for this authorization agreement.
Finally, in Part V, authorize the contractor by signing and dating the form. Ensure that all information is correct before submitting it through our platform.
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42 CFR 424.510 - Requirements for enrolling in the
In order to receive Medicare payments via EFT, providers and suppliers must submit the CMS-588 form. (3) Signature(s) required on the enrollment application.Read more
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