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Form CMS-1490S (version 01/18) DEPARTMENT OF HEALTH AND HUMAN SERVICES. CENTERS FOR MEDICARE MEDICAID SERVICES. PATIENTS REQUEST FOR MEDICAL PAYMENT.
How do I submit a bill to Medicare for reimbursement?
File your claim for Medicare reimbursement Send your completed form, itemized bill, letter and supporting documents (if any) to the Medicare administrative contractor in your state. Medicare claims cant be filed onlinethey must be submitted by mail.
What is the form for Medicare Part D reimbursement?
Form CMS-1696 can be downloaded at .cms.gov or obtained by calling the Customer Service number on your member ID card. The claim may be submitted via mail or fax to the address or phone number on the Medicare Part D Prescription Drug Claim Form.
What is a Medicare reimbursement form?
If you have Original Medicare and wish to file for reimbursement, you need CMS Form 1490-S , the Patients Request for Medical Payment. This form is available in English and in Spanish. Youll provide information about the claim including your name, address, Medicare number, and other contact information.
What is Medicare Part D EOB?
Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an Explanation of Benefits (EOB). This notice gives you a summary of your prescription drug claims and costs.
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Claim Form. Aetna Pharmacy Management. PO Box 52444. Phoenix, AZ 85072-2444. FAX: 1-888-472-1128. Aetna Member Number (claim cannot be processed without number).
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