- Medicare Provider/Supplier Specialty Codes
- CMS-855I Completion Tips for Managing Employee Information in Section 6
- CMS-20134 Completion Tips for Medicare Diabetes Prevention Program Suppliers
- CMS-855I Completion Tips for Physicians and NPPs that Reassign All Benefits Revalidation Application
- Medicare Provider/Supplier Provider Type Codes
- CMS-855O Completion Tips for Physicians or Eligible Professionals for the Sole Purpose of Ordering, Certifying or Prescribing Part D Drugs
- CMS-855B Completion Tips for Clinics/Group Practices and Other Suppliers Revalidation Application
- PECOS Starter Guide
- Resolving PECOS Common Errors and Warnings
- CMS-855B Completion Tips for Ownership Interest and/or Managing Control Information
- CMS-855I Completion Tips for Physicians and NPPs in Private Practice (Sole Owner or Sole Proprietor) Revalidation Application
- Supporting Documentation Required for Enrollment Revalidations
- Understanding Participating, Nonparticipating and Opt Out Status
Supporting Documentation Required for Enrollment Revalidations
Submit all required documentation based on your revalidation scenario:
- Written confirmation from the IRS confirming your legal business name and EIN (e.g., IRS CP-575)
- The legal business name as it appears on Social Security records and/or IRS documents must match the NPPES Registry exactly, including any suffix such as PC, PA, LLC, etc.
- Copy of national certification and diploma for nonphysician practitioners that require it
- Copy of DEA certificate for providers when applicable.
- Copy of the application fee receipt if you are required to pay the application fee
- Complete Form CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement CMS-588
- This form CMS-588 is not required if:
- the current EFT agreement was submitted on the 05/10, 09/13, 01/17 or 12/23 version of the CMS-588 form,
- the EFT information was submitted via PECOS, under the PECOS topic “Electronic Funds Transfer,”
- an individual provider reassigns all benefits.
- This form CMS-588 is not required if:
For revalidation submitters using PECOS, the Financial/Electronic Funds Transfer Topic replaces the need for a CMS-588 paper agreement. If you are making changes to EFT information in PECOS, you should upload (PDF or TIFF) a voided check or confirmation on bank letterhead listing name on the account, electronic routing transit number, account number, account type and bank officer’s full name and signature.
Related Content
- CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement CMS-588
- Electronic Funds Transfer Form and Instructions
- NPPES NPI Registry
Revised 7/29/2024