how to file claim for medicare blue rx prescription

To submit a claim to Blue MedicareRx send your request for payment (claim form) and your payment receipt. Please make a copy of your receipt for your records before you send the original. Download the claim form

Full Answer

How do I file a Blue Cross insurance claim?

Make sure to keep a copy of the receipts for your records. Mail your claim form and receipts to the address listed on the form. Your Blue Cross ID card. Your plan's claim form.

How do I ask for reimbursement for my Prescription?

When you're getting a prescription filled, the pharmacy usually just bills us electronically. However, sometimes you may have to pay up front for prescription drugs that your insurance covers. You can ask us to pay back that expense. Choose the appropriate form below. You may also request reimbursement for your prescription electronically.

How do I file a Medicare claim?

Contact your doctor or supplier, and ask them to file a claim. If they don't file a claim, call us at 1-800-MEDICARE (1-800-633-4227). TTY: 1-877-486-2048. Ask for the exact time limit for filing a Medicare claim for the service or supply you got.

What receipts do I need for a blue cross claim?

Your Blue Cross ID card. Your plan's claim form. Original receipts from the doctor's office or pharmacy. Make sure to check your claim form for a list of what information your receipts need to include.

How do I get reimbursed for a prescription?

Claims filed within 30 days of the prescription being filled can be directly reimbursed through the pharmacy where the prescription was filled/purchased. The plan member will need to present their carrier ID card and a receipt showing the amount they originally paid.

Can I submit a claim directly to Medicare?

If you have Original Medicare and a participating provider refuses to submit a claim, you can file a complaint with 1-800-MEDICARE. Regardless of whether or not the provider is required to file claims, you can submit the healthcare claims yourself.

How do I get Medicare reimbursement?

How to Get Reimbursed From Medicare. To get reimbursement, you must send in a completed claim form and an itemized bill that supports your claim. It includes detailed instructions for submitting your request. You can fill it out on your computer and print it out.

What is the first step in submitting Medicare claims?

The first thing you'll need to do when filing your claim is to fill out the Patient's Request for Medical Payment form. ... The next step in filing your own claim is to get an itemized bill for your medical treatment.More items...•

What form is used to send claims to Medicare?

CMS-1500 claim formThe CMS-1500 claim form is used to submit non-institutional claims for health care services provided by physicians, other providers and suppliers to Medicare.

How long do you have to submit a claim to Medicare?

12 monthsPolicy: The time limit for filing all Medicare fee-for-service claims (Part A and Part B claims) is 12 months, or 1 calendar year from the date services were furnished. This policy is effective for services furnished on or after January 1, 2010.

How do I get my $800 back from Medicare?

All you have to do is provide proof that you pay Medicare Part B premiums. Each eligible active or retired member on a contract with Medicare Part A and Part B, including covered spouses, can get their own $800 reimbursement.

What is Blue Cross Blue Shield Medicare reimbursement account?

Medicare Reimbursement Account (MRA) Basic Option members who pay Medicare Part B premiums can be reimbursed up to $800 each year! You must submit proof of Medicare Part B premium payments through the online portal, EZ Receipts app or by fax or mail.

Who files Medicare supplement claims?

Your Medicare Part A and B claims are submitted directly to Medicare by your providers (doctors, hospitals, labs, suppliers, etc.). Medicare takes approximately 30 days to process each claim.

How do I make a Medicare claim online?

Sign in to myGov and select Medicare. If you're using the app, open it and enter your myGov pin. On your homepage, select Make a claim. Make sure you have details of the service, cost and amount paid to continue your claim.

How do I fill out a CMS 1500 form?

14:5319:58How-to Accurately Fill Out the CMS 1500 Form for Faster PaymentYouTubeStart of suggested clipEnd of suggested clipField 1 is the very first field on the CMS 1500 form and it tells the insurance carrier the categoryMoreField 1 is the very first field on the CMS 1500 form and it tells the insurance carrier the category of insurance that the policy falls into. It can be left blank.

Does Medicare accept secondary paper claims?

Currently, Medicare does not accept electronically filed claims when there is more than one payer primary to Medicare. Claims that involve more than one primary payer to Medicare must be submitted on the 1500 paper claim form, with all appropriate attachments.

How to file a medical claim?

Follow the instructions for the type of claim you're filing (listed above under "How do I file a claim?"). Generally, you’ll need to submit these items: 1 The completed claim form (Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB]) 2 The itemized bill from your doctor, supplier, or other health care provider 3 A letter explaining in detail your reason for submitting the claim, like your provider or supplier isn’t able to file the claim, your provider or supplier refuses to file the claim, and/or your provider or supplier isn’t enrolled in Medicare 4 Any supporting documents related to your claim

What to call if you don't file a Medicare claim?

If they don't file a claim, call us at 1-800-MEDICARE (1-800-633-4227) . TTY: 1-877-486-2048. Ask for the exact time limit for filing a Medicare claim for the service or supply you got. If it's close to the end of the time limit and your doctor or supplier still hasn't filed the claim, you should file the claim.

How long does it take for Medicare to pay?

Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share. For example, if you see your doctor on March 22, 2019, your doctor must file the Medicare claim for that visit no later than March 22, 2020.

When do you have to file Medicare claim for 2020?

For example, if you see your doctor on March 22, 2019, your doctor must file the Medicare claim for that visit no later than March 22, 2020. Check the "Medicare Summary Notice" (MSN) you get in the mail every 3 months, or log into your secure Medicare account to make sure claims are being filed in a timely way.

Does Medicare Advantage cover hospice?

Medicare Advantage Plans provide all of your Part A and Part B benefits, excluding hospice. Medicare Advantage Plans include: Most Medicare Advantage Plans offer prescription drug coverage. , these plans don’t have to file claims because Medicare pays these private insurance companies a set amount each month.

Do you have to file a claim with Medicare Advantage?

Medicare services aren’t paid for by Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage. , these plans don’t have to file claims because Medicare pays these private insurance companies a set amount each month.

What happens if a pharmacy can't fill a prescription?

If your network pharmacy can't fill a prescription, the pharmacist will show you a notice that explains how to contact your Medicare drug plan so you can make your request.

What is formulary in medical terms?

formulary. A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list. .

What is EOC in Medicare?

Medicare prescription drug coverage appeals. Your plan will send you information that explains your rights called an " Evidence of Coverage " (EOC). Call your plan if you have questions about your EOC. You have the right to ask your plan to provide or pay for a drug you think should be covered, provided, or continued.

What is coverage determination?

A coverage determination is the first decision made by your Medicare drug plan (not the pharmacy) about your. benefits. The health care items or services covered under a health insurance plan. Covered benefits and excluded services are defined in the health insurance plan's coverage documents. , including these: Whether a certain drug is covered.

How many levels of appeals are there for Medicare?

Your Medicare drug plan will send you a written decision. If you disagree with this decision, you have the right to appeal. The appeals process has 5 levels. If you disagree with the decision made at any level of the process, you can generally go to the next level.

Should prior authorization be waived?

You or your prescriber believes that a coverage rule (like prior authorization) should be waived. You think you should pay less for a higher tier (more expensive) drug because you or your prescriber believes you can't take any of the lower tier (less expensive) drugs for the same condition.

How long does it take to get paid for a prescription?

If your claim is approved, you will be paid within 30 days after your request is received. You must submit your claim within 36 months (3 years) of the date you received the service, item or prescription drug.

Can you ask Basic Blue RX to pay you back?

Other times, you may find that you paid more than expected. In either case, you can ask Basic Blue Rx to pay you back by submitting a claim. How to submit your claim.

When Do I Need to File A Claim?

How Do I File A Claim?

• Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). You can also fill out the CMS-1490S claim form in Spanish.

See more on medicare.gov

What Do I Submit with The Claim?

Where Do I Send The Claim?