Beneficiaries must understand the Medicare claims filing process to receive timely reimbursement for covered services and supplies.
This article provides an overview of the Medicare claims filing procedure, including the required forms and submission instructions.
Filing For Medicare Claims
Healthcare providers and suppliers are required by law to submit Medicare claims on behalf of Original Medicare beneficiaries for covered services and supplies.
On the other hand, Medicare Advantage Plans (Part C) receive a fixed monthly payment and are not required to file claims. In most instances, beneficiaries should not be required to register their own claims.
Nonetheless, there are a few instances in which this is required. It is essential to adhere to the registration deadlines so that Medicare’s portion can be paid promptly.
Medicare claims must be submitted within 12 months (or one complete calendar year) of the date services were rendered. Medicare will be unable to cover its portion if a claim is not submitted within this window.
Beneficiaries can monitor claim submissions by reviewing the “Medicare Summary Notice” (MSN) they receive every three months or by logging into their secure Medicare account.
Beneficiaries must take the following actions if a healthcare provider or supplier fails to submit a claim within the allotted time frame:
- Contact the physician or provider directly and request that they submit a claim.
- Contact Medicare at 1-800-MEDICARE (1-800-633-4227) or TTY: 1-877-486-2048 if the claim has not been lodged. Determine the deadline for submitting a Medicare claim for the service or supply received.
- If the deadline is approaching and the provider or supplier has not yet submitted the claim, the beneficiaries must file the claim themselves.
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Where To Submit The Application?
Beneficiaries must complete the Patient Request for Medical Payment form to submit a Medicare claim (CMS-1490S). This form, available in English and Español, is the official claim form. Beneficiaries submitting a claim should include the following items:
- Formal claim form: Patient Proposal for Medical Payment form (CMS-1490S).
- A bill itemized by the healthcare provider, physician, or supplier.
- A letter explaining the reason for not submitting the claim, such as the provider’s incapacity, refusal, or non-enrollment in Medicare.
- Any relevant supporting documentation for the claim.
The claim submission address can be located in two locations: On the second page of the claim form’s accompanying instructions.
The “Medicare Summary Notification” (MSN). Beneficiaries can sign up on their Medicare account to receive their MSNs electronically.
Beneficiaries must complete a “Authorization to Disclose Personal Health Information” form if they want someone other than themselves to call 1-800-MEDICARE on their behalf or if they want Medicare to share their personal information with a specific individual (PDF).
Beneficiaries must know how to submit Medicare claims in order to receive timely reimbursement for covered services and supplies.
By comprehending the required forms and following the provided instructions, individuals can ensure that their claims are processed accurately and expeditiously. Remember to monitor claim submissions and take appropriate action if providers miss the deadline for submitting claims.
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