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How to File a Medicare Claim


Most of the time, you won’t need to worry about filing your own Medicare claims. Since most providers accept Medicare assignment, they file the claim for you.  However, knowing how to do it will come in handy in case you need to file your own claim.

If you need to file a Medicare claim, it’s possible the provider you saw doesn’t accept Medicare assignment. Your claim goes according to Medicare reimbursement rates, even if the bill was more than Medicare’s amount. Medicare claims must be sent in no later than 12 months after the service.

If you need to file your own Medicare claim, you’ll need to fill out a Patient Request for Medical Payment Form, the 1490S. Make sure it’s filed no later than 1 full calendar year after the date of service. Medicare can’t pay its share if the submission doesn’t happen within 12 months. You can log in to MyMedicare.gov and view your claims to ensure they are being filed in a timely fashion. If your claims aren’t being taken care of, contact the doctor and ask them to file the claim.

Patient Request for Medical Payment Form (CMS-1490S)

The form you need to fill out is called the Patient Request for Medical Payment Form (CMS-1490S). You’ll need to include an itemized bill from the provider, a detailed letter that explains why you’re filing, and any supporting documents.

The instructions for each type of Medicare claim are slightly different; you’ll want to follow the steps specific to the reason you’re submitting the claim. Claims for Part B services, Durable Medical Equipment, medical services received on a ship, services in Canada or Mexico, and claims for services in a foreign hospital each have different requirements.

To complete an itemized bill include:

  • the date of service
  • a description of service, the charge for each service
  • name/address of the doctor
  • the place of service.

The address to send your claim can be found on the second page of the instructions for the type of claim you’re filing. You can also look at your Medicare Summary Notice.

When you file more than 12 months after the service it will likely receive a denial. Timely action is necessary. Keeping track is simple, you can even get your Medicare Summary Notice electronically.

The Medicare Summary Notice (MSN) is a form beneficiaries get in the mail every 3 months; this form shows all Part A and Part B services or supplies billed to Medicare in the last 3 months. It also shows Medicare’s payment and the amount you may owe the provider.

If you notice a service falsely put on your statement you can report Medicare fraud, waste, or abuse. Looking over the documents Medicare sends you is very important.

How Do I Keep Track of Claims Online

You can easily check the status of Medicare claims by visiting MyMedicare.gov; all you need to do is log into your account. Most claims are sent in within 24 hours of Medicare processing.You can even get your MSN online; sign up to receive eMSNs and get monthly emails that link you to your claim details. With this, you get the most up to date information and no waiting 3 months for a letter.

Medicare is trying to make it simple for beneficiaries; there are many tools that can help you complete any form or document all on your own. Although, if you find that you need help with your claim, don’t hesitate to contact someone.

FAQ’s

What is a Medicare Claim Number?
A Medicare claim number is the number Medicare uses to track your claim. Most likely this number is your social security number with a letter after it.
How Do I Get a Medicare Claim Number?
The fastest way is to create and log into your MyMedicare.gov account. There you’ll find your claim status and associated claim number. Or you can call Medicare directly.
How Long Does Medicare Have to Pay a Claim?
Medicare can take up to 30 days to process your claim.

How to Get Help With Medicare Claims

If you need assistance you can always contact Medicare to file a claim. If possible, you can also ask the doctor to file the claim for you; however, if they won’t, then it’s your responsibility.

MedicareFAQ has helped thousands of Medicare beneficiaries just like you; we help you find the best plan, enroll, assist you with issues, answer any questions, and even help you file a Medicare claim or appeal a denial of a Medicare claim.

Having to submit your own Medicare claim is rare, but it happens. If you frequently see a doctor outside the country that doesn’t accept Medicare assignment, or if a supplier isn’t submitting your claim in a timely fashion, then you must file the Medicare claim yourself.

We have a Client Care Team that can help you every step of the way. When you enroll in supplemental Medicare through us, you have us to help you through any claim issue.

We have an agent in your state; call the phone number above and get the coverage you need. If you wish to see your supplemental Medicare options now, fill out our online rate form.

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Lindsay Engle

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

2 thoughts on “How to File a Medicare Claim

  1. Hi Lindsay, my name is Robert Shannon. On April 8, 2019 I had hip replacement surgery as a result of a fall, and a diagnosis of AVN(Avascular Necrosis). My orthopedic surgeon sent me to Preferred Imaging in Plano, Texas for an MRI. I just found out that they never filed for Medicare to cover this procedure. The reason I never found this out was because I didn’t receive a bill and they were covered under an LOP from my attorney who represented me in a law suit due to my fall. This money is owed to them, but do I have any recourse due to their failure to file, and/or can the time period that the amount was in litigation be factored in to allow for a late filing?

    I am at a loss as to what to do. Will you please help me with this conundrum I have found myself in?

    Thank you, Robert.

    1. Hi Robert! This is a tough one. The claim must be filed no later than 12 months after services were provided. It seems you have passed that 1-year deadline. An LOP is usually used when the plaintiff has no health insurance. If you had Medicare, then your doctor should’ve just billed Medicare for the surgery instead of accepting a LOP from your attorney. It’s my understanding that your doctor should’ve been paid for his services with your settlement funds. It sounds like you may have lost the lawsuit, and now the doctor is suing your attorney for the cost of the surgery. Unfortunately, this may be something you have to settle between you and your lawyer since he/she is the one who gave your doctor the LOP that stopped them from billing Medicare for your surgery in time. You may be able to get additional information from Medicare. I would call Medicare to see if there is an extension to file the claim due to the litigation. Sorry I couldn’t help more!

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