Q:

What information is necessary to file a Medicare claim?

A:

Quick Answer

Health care providers and medical suppliers who submit claims for payment by Medicare Part B on form CMS-1500 must include specific information about the patient, the services provided, other health insurance coverage and the physician or other personnel who provided the care, as Noridian Healthcare Solutions instructs. Depending on the type of services or supplies, those filing claims must attach additional documentation to the submission for Medicare to process the claim.

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Full Answer

On the CMS-1500 claim form for Medicare, the type of health insurance coverage must be indicated in addition to the patient's Medicare Health Insurance Claim Number, full name, mailing address and telephone number, according to Noridian Healthcare Solutions. The insured's policy group number is required, and if applicable, an Explanation of Benefits from the primary insurance company is also required.

Medicare claims require the name and the NPI number of the physician who made the referral or ordered the supplies, if applicable, advises Noridian Healthcare Solutions. The name and the NPI number of the health care professional who provided the services to the patient are required along with the NPI of the billing provider. The service location name and address are required, and the date the patient received the services must appear on the claim form. Additionally, the claimant must use the appropriate Healthcare Common Procedure Coding System codes to identify the procedures, services or supplies provided to the patient.

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