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Practice Manager Form

EFT Authorization Agreement (CMS 588)

A downloadable Practice Manager form for healthcare professionals.
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About this form

The form is used to authorize electronic payments from the Centers for Medicare & Medicaid Services (CMS). It documents the reason for submission, provider or supplier identifiers, tax and NPI information, financial institution details, and required authorizations to establish or update direct deposit for Medicare payments. Completing this form in Heidi supports organized documentation and assists practices in managing EFT enrollment or changes in accordance with CMS and Medicare Administrative Contractor requirements.

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How to use this form

1

Download the PDF

Click the download button to save the form to your device

2

Print or fill digitally

Print the form for handwritten use or fill it out using a PDF editor

3

Use in your practice

Integrate the completed form into your patient records and workflows

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Practice Manager

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Form

Last edited

26/1/2026

Created by

Heidi Team

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