Processing Medicare Insurance Claims: Do You Need To Take Action?



Four Don’t Miss Deadlines For Receiving Medicare Insurance Claims Benefits, Plus Hints To Simplify The Process

As a senior citizen, you are diligent about keeping up with your personal health care. Your calendar is marked with follow up appointments. The pharmacy phone number and contact name are tacked to the refrigerator. It’s just as important to stay informed about the status of your medicare insurance claim.

Provider To File Claims Within One Year

After you receive a service from your doctor, chiropractor, or other provider, it is the responsibility of the provider to file a claim with Medicare in order to receive a fee for their service. They must file the claim within one year. Ask your doctor for the name of the person in their office who handles the processing of medicare insurance claims.

Ensure Claim Is Submitted

Medicare insurance claims are submitted electronically, and, like in many office situations, can be subject to human error or computer error. If you do not receive a notification from Medicare of their receipt of a claim submitted by your porvider within four months, you should contact the Medicare processor in your doctor’s office to ask that the claim be resubmitted.

Is It Necessary For You To Submit A Claim Yourself?

If 8 months have passed and you have exhausted all efforts to have your doctor’s office file your medicare insurance claims, it will be necessary for you to file a Medicare claim yourself. Do so by filling out a Patient’s Request for Medicare Payment form (also called the CMS-1490S form). Print and read the instructions carefully.

Appealing A Medicare Decision

After your medicare insurance claims are filed, if you receive a Medicare Decision which you did not expect or feel is unfair, consider appealing the decision. In Medicare language this is called asking for a “Redetermination.” A request for Redetermination must be filed within 120 days of the date of the notice you receive from medicare of their original decision. Instructions for submitting an appeal will be included with the notice you receive from medicare. Be specific and clear in your appeal, and include complete contact information.



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