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REQUEST for FUNDS TRANSFER & ABC CDR TC ISSUANCE Form

REQUEST for FUNDS TRANSFER & ABC CDR TC ISSUANCE Form

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[Music] foreign thanks for your time today I'm here to provide directions on completing the electronic funds transfer form the form is CMS 5da and is available on the CMS website I'll link to the form is available in the description of this video my name is Tom Ryan with provider origin education I'll provide the information and instructions for the form Medicare requires claims payment to be sent to your bank from our bank this is the electronic funds transfer or EFT process We Gather EFT information during the provider enrollment process this includes new enrollees revalidation change of ownership or other actions keep in mind if you're enrolling and reassigning all your benefits which means an organization or facility will receive all payments then you do not need to complete this form if you or your provider will receive any payments then you need to complete the form the EFT form is a separate form then the provider enrollment forms when needed an EFT form must accompany the provi

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