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Medicare claim 1500 Form: What You Should Know

Fill out your claims, including all relevant information, Complete one side of the claim. Send the other side with an email or fax to CMS.gov. Mail the completed claim form(s) to your local Medicaid office. Your claim will be processed and a statement sent to you via mail. Why do I have to sign the claim form? To protect your rights, you are required to sign the CMS-1500 medical claim form. To complete the medical claim form, you must sign it using a standard form of identification, such as a driver's license, American Express card, Social Security card or tribal identification card . If you cannot sign any document, complete an IRS Form W-8BEN along with a copy of a valid I-9 form. This statement should be included with your claim. Do not sign, date or attach any information not related to the claim, until you sign the form and have all required information ready. Who can I file a claim for? A Medicare Beneficiary (A Beneficiary means anyone who is under the age of 65) The patient must be: A Medicaid beneficiary  Medicaid Beneficiaries Can be under the age of 65. If you have Medicaid or other type of insurance, or insurance that covers you directly, do not sign the statement or fax to CMS.gov. Instead,  Complete the Medicare Claims Payment Verification form, and attach it to the claim and your doctor's or nurse's appointment records with your insurance or Medicare. Do not fax the verification form directly to CMS.gov. You must fax the form to the Medicare Claim Services Center at. The fax number is the same as the telephone number for CMS.gov. You can also write the verification code on one side and the claim number on the other. The code will be included with your claim after it is processed. Do I have a doctor or nurse? No, you do not. You must have a doctor or nurse who knows that you are applying for Medicare. What must I include on the claim? Complete the form. A valid email address, or other method for you to provide this information to the Medicare claim services center. You may be required to attach an itemized statement that includes:  The name and address of the person to whom the service is being rendered.

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