What Is Medicare Claims Processing?


Quick Answer

The process for filing a Medicare claim involves filling out the Patient Request for Medical Payment form and mailing the completed form to the address provided in the instructions, according to Medicare.gov. Individuals should file a claim within 12 months after receiving medical services.

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Full Answer

Health care providers and suppliers are responsible for filing Medicare claims for covered medical services and supplies a person receives under Original Medicare, notes Medicare.gov. Medicare Advantage Plan, or Part C, beneficiaries do not need to file claims; Medicare makes set monthly payments to the private insurance firms. It is crucial to file claims within the set time limit; Medicare does not make payments if claims are not filed on time.

To ensure the timely filing of claims, Medicare beneficiaries should review the Medicare Summary Notice they receive through the mail once every three months or sign in to MyMedicare.gov, recommends Medicare.gov. They should request their doctors or suppliers to file a claim if claims are not being filed promptly. They may also call 1-800-MEDICARE to find out the exact deadline for filing claims.

Medical beneficiaries can file the claim on their own if their health care providers or suppliers fail to file a claim, states Medicare.gov. Those who want to authorize Medicare to share their personal details to another person should submit the Authorization to Disclose Personal Health Information form.

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