Data Fields in Medicare EFT Enrollment

Electronic Funds Transfer (EFT) allows Medicare to transfer payments directly to the provider’s financial institution. The Medicare EFT Authorization Agreement (CMS-588) is required for: 

  • new provider enrollments;
  • enrolled providers who are not already on EFT; and
  • requesting a change to your existing EFT account information.

Most providers find EFT (Electronic Fund Transfer) and ERA (Electronic Remittance Advice) enrollment difficult. In this article, We shared important data fields for Medicare EFT enrollment. Most of the are ‘required’ data fields and keeping them blank or sharing wrong information may reject or delay your application. A basic understanding of them would help to enroll with Medicare quickly and without any error.

Data Fields in Medicare EFT Enrollment

Provider Information

  • Provider Name: This field must contain the complete legal name of the institution, corporate entity, practice, or individual provider. 
  • Doing Business As Name (DBA): A legal term used in the United States meaning that the trade name, or fictitious business name, under which the business or operation is conducted and presented to the world is not the legal name of the legal person (or persons) who actually own it and are responsible for it. 

Provider Address 

  • Street: The number and street name where a person or organization can be found
  • City: City associated with provider address field
  • State/Province: Two Character Code associated with the State/Province/Region of the applicable Country
  • ZIP Code/ Postal Code: ZIP Code/ Postal Code
  • Country Code: Country Code

Provider Identifiers

  • Provider Federal Tax Identification Number (TIN) or Employer Identification Number (EIN): A Federal Tax Identification Number, also known as an Employer Identification Number (EIN), is used to identify a business entity.
  • National Provider Identifier (NPI): The NPI is a unique identification number for covered healthcare providers. Covered healthcare providers and all health plans and healthcare clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10- position, intelligence-free numeric identifier (10-digit number). 

Other Identifier(s)

  • Assigning Authority (required if Identifier is collected): Organization that issues and assigns the additional identifier requested on the form, e.g., Medicare, Medicaid
  • Trading Partner ID (optional): The provider’s submitter ID assigned by the health plan or the provider’s clearinghouse or vendor

Provider License Number

  • Provider Type: A proprietary health plan-specific indication of the type of provider being enrolled for EFT with a specific provider type description included by the health plan in its instruction and guidance for EFT enrollment (e.g., hospital, laboratory, physician, pharmacy, pharmacist, etc.)
  • Provider Taxonomy Code: A unique alphanumeric code, ten characters in length. The code set is structured into three distinct ‘Levels’ including Provider Type, Classification, and Area of Specialization.

Retail Pharmacy Information

  • Pharmacy Name: Complete name of the pharmacy
  • Chain Number (optional): Identification number assigned to the entity allowing linkage for a business relationship, i.e., chain, buying groups, or third-party contracting organizations. Also maybe known as Affiliation ID or Relation ID
  • Parent Organization ID (optional): Headquarters address information for chains, buying groups, or third-party contracting organizations where multiple related entities exist and need to be linked to a common organization such as common ownership for several chains
  • Payment Center ID (optional): The assigned payment center identifier associated with the provider/corporate entity

Financial Institution Information

  • Financial Institution Name: Official name of the provider’s financial institution
  • Financial Institution Telephone Number: A contact telephone number at the provider’s bank
  • Financial Institution Routing Number: A 9-digit identifier of the financial institution where the provider maintains an account to which payments are to be deposited
  • Type of Account at Financial Institution: The type of account the provider will use to receive EFT payments, e.g., Checking, Saving
  • Account Number Linkage to Provider Identifier: Provider preference for grouping (bulking) claim payments, must match preference for v5010 X12 835 remittance advice

Submission Information

  • Voided Check: A voided check is attached to provide confirmation of Identification/Account Numbers
  • Bank Letter: A letter on bank letterhead that formally certifies the account owner’s routing and account numbers
  • Authorized Signature: The signature of an individual authorized by the provider or its agent to initiate, modify or terminate an enrollment. It May be used with electronic and paper-based manual enrollment 
  • Submission Date: The date on which the enrollment is submitted (CCYYMMDD: The date format is MM/DD/CCYY where MM represents a two-digit month, DD represents a two-digit day of the month, CC represents a two-digit century, and YY represents a two-digit year.)
  • Requested EFT Start/Change/ Cancel Date: The date on which the requested action is to begin (CCYYMMDD)

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