What Is the Mailing Address for Medicare Part B Claims?

Medicare Part B helps cover medically necessary services and supplies, including doctor visits, outpatient care, and some preventive services. Beneficiaries typically do not need to file claims themselves because providers usually submit them directly to Medicare. However, understanding the claims process is important for situations where direct billing does not occur, ensuring proper payment for covered services.

When to Mail a Medicare Part B Claim

Most healthcare providers who accept Medicare will submit claims directly to Medicare on your behalf. However, there are specific situations where you might need to mail a Medicare Part B claim yourself. This often occurs when you receive services from a provider who does not accept Medicare assignment. A non-participating provider may still treat Medicare beneficiaries but chooses not to accept Medicare’s approved amount as full payment.

In such cases, the provider can bill you directly for the services, and you would then be responsible for submitting the claim to Medicare for reimbursement. Similarly, if you pay for a service upfront from any provider, whether participating or not, and the provider does not submit a claim, you would need to file the claim yourself to seek Medicare reimbursement. Medicare claims must be filed no later than 12 months, or one full calendar year, after the date when the services were provided.

Preparing Your Medicare Part B Claim Form

When you need to mail a Medicare Part B claim, you will use the CMS-1500 form, which is the standard form for healthcare providers to bill Medicare and other insurance programs. You will need to provide your full name, Medicare Beneficiary Identifier (MBI), and contact information, as well as the date of birth and gender of the person who received the services.

Information about the healthcare provider who rendered the services is also necessary, including their name, address, and National Provider Identifier (NPI). You must include detailed information about the services you received, such as the date of service, the place of service, and a description of each service with its corresponding procedure code. The diagnosis code or codes that explain why the services were medically necessary must also be entered. Finally, the form requires the charges for each service and the total amount billed.

Locating Your Medicare Part B Claim Mailing Address

Finding the correct mailing address for your Medicare Part B claim is important, as there is no single universal address for all claims. The appropriate address depends on the specific Medicare Administrative Contractor (MAC) that processes claims for your geographic region. MACs are private health care insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims. Each MAC serves a particular set of states or territories.

To locate the correct mailing address, you should visit the official Medicare website, Medicare.gov. On the website, you can find your MAC based on your state of residence. Once you identify your MAC, their specific mailing address for submitting paper claims will be provided.

Submitting Your Claim and Tracking Its Progress

After preparing your CMS-1500 claim form and identifying the correct mailing address for your Medicare Administrative Contractor, mail the document. Before sending, make a copy of the completed form and any supporting documentation for your personal records.

Once mailed, the processing time for Medicare Part B claims can vary, but it typically takes around 30 to 45 days for Medicare to process a paper claim. You can check the status of your claim online through your MyMedicare.gov account, which provides a secure way to view your claims history and status. Alternatively, you can call 1-800-MEDICARE (1-800-633-4227) to inquire about the status of your submitted claim.