Claim Form For Medicare
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FAQ
The first step in filing a Medicare claim is to complete Medicare Form 1490S, also called the Patient Request for Medical Payment form. You'll submit that document and an itemized bill to your local Medicare contractor.
Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). You can also fill out the CMS-1490S claim form in Spanish (PDF).
Most people on Original Medicare will never need to file a claim?doctors, suppliers or healthcare providers typically submit claims directly to Medicare. However, there are rare cases where people may need to file their own claim. Here's some information to help you file a Medicare claim correctly.
How to fill out a CMS-1500 form The type of insurance and the insured's ID number. The patient's full name. The patient's date of birth. The insured's full name, if applicable. The patient's address. The patient's relationship to the insured, if applicable. The insured's address, if applicable. Field reserved for NUCC use.
Medicare claim process You present your Medicare ID card to your health care provider. Your provider sends your claim to Medicare. Medicare pays first and sends payment directly to the provider. Medicare sends you a statement saying what you owe. You pay the balance to the provider directly.