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Medicare part a claims address po box Form: What You Should Know
P.O. Box 100302 P.O. Box 100301 5 days ago — Payer's Notice of Claim for Part B or Part C—P.O. Box 4009 5 days ago — Claim Forms Form 1450 from P.T. & M.M.S. Health Care Providers. Please complete both parts of the form (MCA/PhD. CMA-13-1). These forms must be filed with the provider and sent back to CMS. Health Care Providers Filing claim from a Primary Care Physician (P.T. & M.M.S.) This page provides you with information specific to primary care doctors filing claims for Part A, Part B or Part C claims; and the specific mail address they are required to submit this claim to. Please use the appropriate link for your provider. Please note that if your provider has a clinical practice, office or clinic location (see map below) then you should visit that location to download the Part B Payer's Notice of Claim form. Provider's contact information for Part B Payer's Notice of Claim Form (U.S. mail) Part A, Part B Claims Payer's Name, Mailing Address, County Medical Part B Patient Request For Medical Payment (P.O. Box 200200, 200200, 300) Meridian, ID 83623 Medicare (P.O. Boxes) P.O. Box 100306, CMA/HMO 3390 Part A, Part B Claims Payer's Name, Mailing Address, County Medical Part B Patient Request For Medical Payment (US Mail) MFA PO Box 469 Hospital P.O. Box 6009 Medicaid (P.O. Boxes) P.O. Box 200196, 200196, 300 Health Care Providers Filing Claim From a Regional Medical Center (HMO) HMO Patient Request Form (USP) MFA HMO Providers filing Claim From a Physician (P.T.) Physician's Patient Request for Medical Payment (P.T.) Patient Request For Medical Payment (PCM) Patient Request Form (PC-02) P.T. & M.M.M.S. Patient Submission Form (U.S. mail) State or Federal Mediation Assistance Program State Mediation P.O.
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