Most Americans never need to file a Medicare claim. Usually, Medicare providers send claims directly to Medicare so their members don’t need to do a thing. However, in some rare cases, people in Original Medicare may need to file their own claims. Follow these steps to make sure you file yours correctly.
When You May Need To File A Medicare Claim
With Original Medicare you might need to file a Medicare claim if:
- Your health provider or supplier can’t file a claim
- Your health provider or supplier won’t file a claim
- Your health provider or supplier isn’t enrolled in Medicare
Check your Medicare Summary Notice issued every month to see whether you have outstanding claims. In most cases, your health provider will resolve these if you bring them to their attention. However, if they are unable to or simply refuse, you will need to file your own Medicare claim.
1. Complete a Patient’s Request For Medical Payment form
Your completed Patient’s Request for Medical Payment (CMS-1490S) form provides most of the information Medicare needs to process your claim.
You should include the following information on your claim form:
- The reasons you received medical care from your chosen health care provider
- Whether you sought treatment for a work-related illness or injury
- Details of any health insurance you hold, including coverage through your employment or spouse’s policy
In addition, you will find slightly different requirements for different services, including:
- Part B services
- Durable medical equipment
- Shipboard services
- Health care services received in Canada or Mexico
- Health care services received in hospitals outside the U.S., Canada, or Mexico
The Medicare website contains information sheets detailing the specific requirements for these specialized claim types.
2. Obtain an itemized bill for your medical treatment
Your itemized bill or bills for medical treatment proves your claim’s validity. Make sure your itemized bill contains the following information to ensure your claim is processed smoothly:
- The date of your treatment
- The place you received treatment (hospital, doctor’s office, etc.)
- Your doctor or medical supplier’s name and address
- Description of each surgical or medical treatment or supply received
- Itemized charge for each treatment or medical supply
- Your specific diagnosis. This may not be necessary on the itemized bill if your Patient’s Request for Medical Payment form contains a thorough illness or injury description
If the bill you received from your health care supplier doesn’t contain these details, contact your physician and request a new one with all the information Medicare requires.
3. Add supporting documents to your claim
As it’s unusual for beneficiaries to file their own claims, you should explain to Medicare why you’re taking this action. This could be for any of the reasons discussed above.
In addition, you should include any documents that can support your claim. These supporting documents could include referrals to specialists and details of your medical history.
You may also need to complete an Authorization to Disclose Personal Health Information form. You should do this if:
- You want someone, such as a spouse or parent, to call the Medicare hotline about your claim on your behalf
- You want Medicare to reveal personal information about yourself and your claim to someone else
Unlike other forms involved in filing a Medicare claim, the Authorization to Disclose Personal Health Information form should be completed and submitted online.
4. Mail completed form and supporting documents to Medicare
Submit your completed Patient’s Request for Medical Payment form, itemized medical bill or bills, and any supporting documents to your state’s Medicare contractor. All claims must be submitted by mail; you can’t file a Medicare claim online. You can find the mailing address for your state’s contractor in a number of ways:
- View the second page of the Medicare instructions for your Medicare claim type
- View your Medicare Summary Notice. If you don’t have a hard copy on hand, you can view an electronic version when you log in to MyMedicare.gov
- Visit the CMS.gov website
The Medicare website can also answer many questions about filing a Medicare claim before you submit your paperwork. If you still have questions, contact Medicare and speak to a representative.
As a beneficiary, you have one calendar year after receiving medical services to file your Medicare claim. If you file your claim after 12 months has elapsed, it will probably be rejected.
Following the right steps will make sure your claim is approved in a timely fashion. We invite you to share this post with your social media contacts so they know how to correctly file a Medicare claim.
Published: January 1, 2019