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How Do I Submit a Claim (Bill) to Medicare?

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You should not need to submit a Medicare claim or bill, but there may be rare circumstances that you may need to. Original Medicare, Part A and Part B, providers (including hospitals, skilled nursing facilities, home health agencies, physicians, pharmacies, and suppliers) that are enrolled in the Medicare program are required by law to file Medicare claims for covered services or supplies you receive. Medicare claims must be filed within one full calendar year following the year in which the services were provided.

If you receive a service or supply from a health-care provider who does not accept Medicare assignment, you might have to pay the entire charge at the time of service.

If a claim isn’t filed within the time limit, Medicare may not pay its share. It’s important to check your Medicare Summary Notice (MSN) to make sure your claims are being filed on time. If you discover claims are not being filed in a timely manner, you should first contact your physician and/or supplier and ask them to file the claim. If your claim is still not filed once you ask them to, call 1-800-Medicare (1-800-633-4227), TTY users 1-877-486-2048; 24 hours a day, 7 days a week. You can also file the claim yourself by submitting the Patient Request for Medicare Payment form (CMS-1490S).

Note: If you get your Medicare health-care benefits through a Medicare Advantage (MA) plan such as an HMO (Health Maintenance Organization) or a Private Fee-For-Service plan, then the claims are filed with the Medicare Advantage plan. Medicare pays these private insurance companies a set amount every month to administer and manage your benefits. Therefore, a separate claim does not need to be filed with Medicare.

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