Health

Medicare Claims: How to File and Track Your Claims

March 18, 2025March 18, 2025 by Luke Güemes

A Medicare claim is a request for payment that is submitted to Medicare for services, supplies, or treatments covered under your plan. In most cases, your healthcare provider or supplier files the claim for you. However, in certain situations, you may need to file the claim yourself.

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What is a Medicare Claim?

Who Files Medicare Claims?

Healthcare providers and suppliers: Most doctors, hospitals, and suppliers bill Medicare directly.
You (the beneficiary): If your provider doesn’t accept Medicare or refuses to file the claim, you may need to submit it yourself.

When Should You File a Medicare Claim?

You should file a claim if:
✅ Your provider did not submit the claim within 12 months from the date of service.
✅ You were charged for a covered service or item that Medicare should pay for.
✅ You received care from a foreign provider (in limited cases).

How to File a Medicare Claim

If you need to submit a claim yourself, follow these steps:

1. Complete the Medicare Claim Form

Download Form CMS-1490S (Patient’s Request for Medical Payment) from Medicare.gov.

2. Gather Supporting Documents

An itemized bill from your provider, including:
- Date of service
- Description of services received
- Provider’s name and address
- Amount charged
Proof of payment (if applicable).
A letter explaining why you are filing the claim (optional but recommended).

3. Submit the Claim to Medicare

Mail your completed form and documents to the Medicare Administrative Contractor (MAC) for your state.

How to Track a Medicare Claim

Online: Log in to your Medicare account
By Phone: Call for claim updates.
Medicare Summary Notice (MSN): You’ll receive a statement in the mail every three months showing processed claims.

What to Do If Your Medicare Claim is Denied

If your claim is denied, you have the right to appeal the decision. Follow these steps:

Include supporting documents and a clear explanation of why you believe Medicare should cover the service.
Review the denial notice in your Medicare Summary Notice (MSN)
Submit an appeal in writing within 120 days of receiving the notice.

Conclusion

Medicare claims are usually filed by providers, but if you need to submit one yourself, it’s important to follow the correct steps. Always keep copies of your medical bills, track your claims, and appeal if necessary.