Effective January 1, 2011, all submitted EFT forms must be in the newest version, which is Form CMS-588 (05/10). CMS will accept the older version until the effective date.
You will find the newest version on the CMS Website at:
All applications for initial provider enrollment require that Form CMS-588, "Electronic Funds Transfer (EFT) Authorization Agreement," be included with the application.
Established providers who are not already receiving payment via EFT, and who are reporting any change to their 855 enrollment information, must submit Form CMS-588 to initiate payment via EFT.
Medicare providers currently receiving EFTs who wish to change their current banking information can do so by completing a new EFT form. Please mark the EFT form as a revision and provide the required information to change your banking information. An EFT power point presentation is available to answer your questions regarding the CMS-588 EFT Agreement at http://www.wpsic.com/edi/tools.shtml. Scroll down to EFT Funds Transfers and go to the EFT Presentation.