How to Process a Claim to Medicare

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Attach itemized bills for medical services to your Medicare claim form.
Attach itemized bills for medical services to your Medicare claim form. (Image: Comstock Images/Comstock/Getty Images)

In most cases, your doctor or medical supplier will file a Medicare claim for you. However, if a doctor or supplier does not file a claim for a service or supply you received, you can file the claim. There is a time limit on how long you have to file a Medicare claim. If you file a claim on your own, Medicare will pay you directly once you submit a completed claim form for processing.

Check your Medicare Summary Notice (MSN) when you receive it in the mail. You can also check your Medicare claims online. Every three months Medicare will mail you a Medicare Summary Notice listing any medical services or supplies that were billed to Medicare within that time frame. If a service or supply does not appear on the MSN, the provider or supplier might not have filed a claim. According to Medicare guidelines, a claim form must be submitted within one calendar year after the year in which you received a medical service or supply.

Print a Medicare claim form available at the website Medicare.gov. Follow the instructions for completing the Patient’s Request for Medical Payment. Type or print your name as it appears on your Medicare insurance card. Fill out the form in its entirety, including your mailing address and telephone number.

Indicate the claim number exactly as it is printed on your Medicare card. Include the letter at the end of the claim number. The letter is a beneficiary code that identifies you as the primary claimant, aged widow or widower, surviving divorced wife or other category.

Describe the illness or injury for which you were treated. Indicate whether the illness or injury was related to your employment or an accident, auto or otherwise.

Attach itemized bills from the doctor or hospital where you received treatment. Medicare will not process the claim if you fail to attach itemized bills to the back of the form. Itemized bills must include the date of service, place of service, a description of each service or medical supply and the charge for each service or supply. An itemized bill should show the doctor or supplier’s name and address in addition to the diagnosis.

Specify on the form whether you are employed and covered under an employee health plan. If you are retired but your spouse is still working, indicate whether you are covered under your spouse’s employee health plan. If you have health insurance coverage other than Medicare, give the name and address of the insurer and the name of the policyholder. Provide the policy number or Medical Assistance number if you get state medical assistance along with Medicare.

Sign and date the form. By signing the form, you give permission for the release of your medical information to the Social Security Administration and Centers for Medicare and Medicaid Services if Medicare has questions when processing your claim.

Mail the completed and signed claim form to your Medicare Carrier. You can also call 1-800-MEDICARE to get the address for the Medicare Carrier that serves your area. A Medicare Carrier is an insurance company that processes Medicare Part A and Part B claims for your region. Different carriers cover different states.

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