How do I know when to file a claim?
When a provider, such as a medical supply company, does not accept a Medicare assignment you will need to begin the process to file a claim for reimbursement.
How do I know what will be reimbursed?
All claim reimbursement is governed by the set standard Medicare reimbursement rates, even if your bill from the provider was more than the approved Medicare amount. Non-participating medical suppliers are not subject to charge limiting but your reimbursement amount will remain the same.
How do I file a claim?
Once you’re ready to file your claim to Medicare you will need a few things to make sure that your claim can be processed quickly and you receive the amount of your set standard Medicare reimbursement rate.
You will need a copy of the Medicare CMS-1490S form (also known as the Patient Request for Medicare Payment form), an itemized bill from your medical supply company, a letter explaining why you are submitting the claim (Medicare not accepted by provider, etc.), and any supporting documentation (such as a prescription, or doctor/physical therapist recommendation form). HME Medical Shop can provide this letter after your purchase. Just call or reply back to your confirmation email!
Do I need to fill out an Authorization to Disclose Personal Health Information?
This form is only necessary if:
- Someone is contacting Medicare on your behalf
- If you are authorizing Medicare to give your personal medical information to someone other than yourself
How long do I have to file for Medicare Reimbursement?
You have 12 months from your service date to file for reimbursement on all purchases covered by Medicare claims.
Once you have all of your information together you will need to submit your claim to the proper Medicare office. They are listed below for your convenience but are also located with the CMS-1490S form.
|If you live in:||Return your form to:|
|Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont||Noridian Healthcare Solutions P.O. Box 6780 Fargo, ND 58108-6780|
|Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin||CGS Administrators, LLC P.O. Box 20013 Nashville, TN 37202|
|Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West Virginia||CGS Administrators, LLC P.O. Box 20010 Nashville, TN 37202-0010|
|Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming||Noridian Healthcare Solutions P.O. Box 6727 Fargo, ND 58108-6727|