Get Medicare Reporting Form

If you have Original Medicare and a participating provider refuses to submit a claim, you can file a complaint with 1-800-MEDICARE. Regardless of whether or not the provider is required to file claims, you can submit the healthcare claims yourself.

Medicare Secondary Payer (MSP) claims can be submitted electronically to Novitas Solutions via your billing service/clearinghouse, directly through a Secure File Transfer Protocol (SFTP) connection, or via Novitasphere portal's batch claim submission or Part B Direct Data Entry (DDE).

Visiting your local Social Security office. Calling Social Security at 800-772-1213. Mailing a signed and dated letter to Social Security that includes your name, Social Security number, and the date you would like to be enrolled in Medicare. Or, by applying online at www.ssa.gov.

Send the completed form and supporting documentation to your Medicare contractor. Reference the Medicare Administrative Contractor Address table for the correct address to mail your claim form. If you still do not know the address of your Medicare contractor, call 1-800-MEDICARE (1-800-633-4227).

Your birth certificate or other proof of birth. Proof of United States citizenship or legal residency, such as a passport. Driver's license.

Start by creating an account on the Social Security Administration's site. You'll need basic information including birth certificate, driver's license, or proof of U.S. citizenship. Decide whether to enroll in Part A only or Parts A and B. Enroll on time or risk a Part B premium surcharge.

The purpose of Section 111 reporting is to enable Medicare to correctly pay for the health insurance benefits of Medicare beneficiaries by determining primary versus secondary payer responsibility. Section 111 authorizes CMS and GHP RREs to electronically exchange health insurance benefit entitlement information.

Initial Enrollment Questionnaire You can fill out the IEQ online at MyMedicare.gov. You should receive a letter in the mail about three months before your Medicare coverage starts with your MyMedicare.gov username, password, and instructions for filling out the IEQ.

How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & ...