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Posting Date: 03/15/2021
Provider Clinics/Group Practices and Other Suppliers
Provider Clinics/Group Practices and Other Suppliers Download CMS-855B. Complete the CMS-855B section 1A by selecting “You are reporting a change to your Medicare enrollment Information,” then in section 1B, check all that apply and [...]
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Posting Date: 11/08/2019
Supporting Documents
Supporting Documents Attach required supporting documentation for individuals or organizations. Submit applicable documents. CMS-588 EFT Authorization Agreement and voided check or bank confirmation letter IRS document confirming your [...]
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Posting Date: 11/12/2021
Supporting Documents
Supporting Documents Attach required supporting documentation for individuals or organizations. Submit applicable documents: CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement and voided check or bank confirmation letter IRS [...]
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Posting Date: 11/12/2021
Electronic Funds Transfer Agreement
Electronic Funds Transfer Agreement Download and complete the CMS-588 Electronic Funds Transfer (EFT) Authorization Agreement. Physicians and nonphysician practitioners who are reassigning all of their payments to another entity are not [...]
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