Get Hhs Cms-1490s 2018-2025

The HHS CMS-1490S form is essential for individuals requesting medical payment from Medicare. This guide provides a clear, step-by-step process to fill out the form effectively and accurately, ensuring your claims are submitted correctly.

Follow the steps to complete the HHS CMS-1490S online.

1. Click the ‘Get Form’ button to access the HHS CMS-1490S form and open it in your preferred online editor.
2. In the first section, enter the patient's information. Fill in the patient's name as it appears on their Medicare card, along with the Medicare number, date of birth, sex, street address, city, state, zip code, and telephone number.
3. Proceed to Section 2 titled 'Information About Services Furnished.' Clearly describe the illness or injury treated. Attach all relevant documentation, including an itemized bill that contains the date of service, place of service, service descriptions, and associated costs.
4. Indicate whether the patient’s condition was related to employment, an auto accident, chronic dialysis, or another type of accident by checking the corresponding boxes.
5. In Section 3, provide information about any health insurance other than Medicare. Complete the details regarding additional medical coverage if the patient is 65 or older and currently enrolled in another health plan.
6. Section 4 requires the patient or a representative to sign and date the form, declaring the truthfulness of the information provided. If the patient cannot sign, instructions for marking an 'X' and having a witness sign are included.
7. Once all sections are completed, ensure you save your changes. You may also choose to download, print, or share the completed form as needed.

Complete your HHS CMS-1490S form online today to ensure your medical payment requests are processed smoothly.