Medicare Forms, Claims, and Appeals

Future and current beneficiaries with Medicare health insurance should be familiar with the many Medicare forms. Enrolling in Part A and understanding how to make appeals and file claims is something all beneficiaries should know.

Once you find the form, filling it out is easy. Many seniors find themselves asking questions such as “How do I file an appeal? How to file a complaint? How to win a Medicare appeal?”.

Many of the forms are conveniently found online at the Medicare website.

Medicare Forms

The Centers for Medicare and Medicaid Services (CMS) require individuals to file certain forms to enroll, appeal or change authority. A task that can seem tedious or overwhelming.

Fortunately, most forms have a PDF file available to download – for free.

New to Medicare Forms

The initial Medicare enrollment applications should be submitted to Social Security; not Medicare. This is a common misconception among seniors.

Enrollment in Medicare isn’t automatic unless you’re receiving Social Security before age 65.

Eligible individuals may apply by visiting a local Social Security office, calling Social Security, or by visiting the Social Security website.

New to Medicare individuals can start by filing out the Initial Enrollment Questionnaire (IEQ). This form determines if Medicare will be primary or secondary for insurance coverage.

About 3 months before benefits begin, a letter is sent including the MyMedicare.gov username and password. The letter will include instructions for filling the IEQ online.

Enrollment Forms

Seniors with Part A coverage will need to apply for Medicare Part B coverage. Those with Part A must fill out the Application for Enrollment in Part B form prior to receiving benefits.

To sign up for Part B while continuing to work, or during the 8-months following employer coverage ending beneficiaries must have the Request for Employment Information Form.

Enroll in Medicare Auto-Payment

Never miss a payment with Medicare Easy Pay. Monthly premium payments automatically deduct from any account of your choice.

No more worrying about payments and due dates. First, fill out the Authorization Agreement for Pre-authorized payments form. The document is online, or you can contact Medicare directly.

How to File a Medicare Claim

Beneficiaries don’t usually file their own Medicare claims. However, if an emergency occurs while out of the country, you may need to make a claim yourself.

While unlikely, other situations may also require beneficiaries to submit their own claims. Should you need to file a claim, the forms are found online.

The Patient Request for Medical Payment form includes options for claims on both supplies and medical services.

Filing an Appeal with Medicare

Beneficiaries that disagree with a payment decision by Medicare, may file an appeal. Appeals come in various levels, each requiring the appropriate form.

One option is to appoint a representative to help with the appeal process by filling out the Appointment of Representative form.

Transferring appeal rights to a specific provider or supplier requires you to file a Transfer of Appeal Rights form.

Although, each appeal may be different. Depending on the situation, you may need to file multiple times. The forms are different each time.

The first level of appeals process may include the initial appeal request form. Requirements include The Redetermination Request form.

Beneficiaries may submit a Medicare Reconsideration Request form if the decision for redetermination isn’t the result they want.

If the 2nd level of appeal is still unsatisfactory, beneficiaries may request a hearing by an Administrative Law Judge (ALJ). This request is made by filling out the Request for Administrative Law Judge Hearing or Review of Dismissal form.

Filing a Complaint with Medicare

Depending on who and what the issue is about, the process for filing a complaint against a Medicare provider may vary. The issue may come from a healthcare establishment or with the Medicare insurance company.

Many confuse an appeal and a complaint as the same, although, they’re completely different.

Appeals are made when a beneficiary doesn’t agree with Medicare’s decisions for coverage. Problems relating to treatment or quality of care are complaints.

File any grievances about a doctor or hospital by contacting the Quality Improvement Organization. Otherwise, complaints can be made with your residential State Health Insurance Assistance Program.

To file complaints about a Medicare plan, submit a Medicare complaint form. Problems with Durable Medical Equipment can be made directly through Medicare.

If you have private Medicare insurance, contact the plan directly to address any complaints.

Authorizing Medicare to Share Personal Health Information

Often, a loved one or spouse may want their partner to fully access their personal health information.

If you find yourself in this situation, fill out and submit the Authorization to Disclose Personal Health Information form. Fill this form out online or contact Medicare directly for the information.

Unlisted Medicare Forms

If you don’t see your situation above or you don’t know the name of the form, contact Medicare directly.

Medicare Advantage or Part D Prescription Drug Plan enrollees must contact their insurance company for the proper claims or appeals forms to submit. Usually the insurance contact information is on the back of your card.

Those with Medigap coverage will still contact Medicare about claims or appeals forms.