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Automatic Transfer Authorization Agreement the Clay City Form

Automatic Transfer Authorization Agreement the Clay City Form

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welcome to enrollment on demand in this video we will learn how to complete the electronic funds transfer authorization agreement form whether submitting a paper form or using pecos by following these step-by-step instructions it will help to avoid delays in application processing the information given in this training is correct as of today the most current information contained in this presentation can be found on the neridian medicare website and the cms website at the links listed on this slide this form is completed by 855a institutions 855b clinics and groups sole proprietors and sole owners it is also used to set up initial report changes and verify for revalidations it is a legal arrangement that tells the mac where to send monies for the account holder the form may be completed through paper or pecos web shown here in this presentation is the paper version of the cms-588 the same information can be reported using pecos the most current form may be obtained from the cms or the

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