If you receive retirement benefits and Medicare through the Railroad Retirement Board, your claims are handled by a separate Medicare Administrative Contractor (MAC) — regardless of which state you live in. Send paper claims and written correspondence to: Palmetto GBA Railroad Medicare Attn: Claims P.O. Box 10066 Augusta, GA 30999-0001
Full Answer
Where are Medicare claims sent to?
There is no central address that all Medicare claims are sent to. Each state works with a company called a Medicare Administrative Contractor (MAC) that handles medical claims for their geographic area.
Does Medicare cover railroad workers and their families?
Medicare for Railroad Workers and Their Families. CMS is the agency in charge of the Medicare program. The Railroad Retirement Board (RRB) enrolls railroad retirement beneficiaries in the program, deducts Medicare premiums from monthly benefit payments, and assists in certain other ways.
What does the railroad Medicare customer service center do?
Beneficiary Customer Service Center Assistance for people with Railroad Medicare. Benefit Integrity Responsible for deterring and detecting fraud, waste and abuse in the Railroad Medicare program. Claims Assistance with filing claims.
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.
Who is in charge of Medicare?
What is Medicare Part A?
What is the enrollment period for Medicare?
How long do you have to be on Medicare to get free medical insurance?
What age does Medicare cover?
When does Medicare Part B become effective?
Does Medicare cover railroad workers?
See more
About this website
Where do I file a railroad Medicare claim?
You can either file electronic claims to Railroad Medicare through a clearinghouse or other third-party claims submitter, or you can submit paperless claims directly through Palmetto GBA's online provider portal eServices eClaims option.
Can you submit paper claims to railroad Medicare?
If you meet an exception to mandatory electronic filing, you can submit your initial paper claim(s) to obtain a Railroad Medicare PTAN.
How do I contact railroad Medicare?
Provider Contact Center: 888-355-9165 Representatives are available Monday through Friday from 8:30 a.m. to 4:30 p.m. for all time zones with the exception of PT, which provides service from 8 a.m. to 4 p.m.
How do I submit a corrected claim to railroad Medicare?
In the case where a minor error or omission is involved, you can request that Railroad Medicare reopen the claim so the error or omission can be corrected rather than going through the written appeals process. Reopenings may be submitted in written form, over the telephone or through our eServices online portal.
What is the payer ID for Medicare Railroad?
MR018Payer Name: Medicare - Railroad|Payer ID: MR018|Professional (CMS 1500)
Is Railroad Medicare same as Medicare?
A: The only difference is that retired railroad beneficiaries have their Part B benefits administered by the Palmetto GBA Railroad Retirement Board Specialty Medicare Administrative Contractor (RRB SMAC) regardless of where they live. Members should be certain to advise providers of this when they receive treatment.
Does railroad Medicare have a provider portal?
Events. Palmetto GBA Railroad Medicare is pleased to offer eServices, our free Internet-based, provider self-service portal. The application provides information access over the Web for the following online services: Eligibility.
Who administers railroad Medicare?
Palmetto GBA is contracted by the independent federal agency Railroad Retirement Board (RRB), which administers comprehensive retirement-survivor and unemployment-sickness benefit programs for railroad workers and their families under the Railroad Retirement and Railroad Unemployment Insurance Acts.
Is railroad Medicare a Medicare Advantage Plan?
Yes, Railroad Medicare beneficiaries can choose to enroll in Medicare Advantage plans.
How do I appeal Railroad Medicare?
You may submit your appeal request in writing or through our website using eServices. Railroad Medicare also accepts redetermination requests via fax at (803) 462-2218. First level of appeal: redetermination. Timeframe: 120 days from the receipt of the initial determination.
How do I check my Railroad Medicare claims?
If you'd like to use the IVR, you can do so by calling 800–833–4455. From the main menu, press one (1) for claim status. You will need your Railroad Medicare number, date of birth, name, and date of service for the claim you are searching for. Claim status is available Monday thru Friday from 7 a.m. through 11 p.m. ET.
Does Medicare accept corrected claims electronically?
A claim correction may be submitted online via the Direct Data Entry (DDE) system.
What is the Claims Mailing Address for Medicare?
There is no central address that all Medicare claims are sent to. Each state works with a company called a Medicare Administrative Contractor (MAC)...
How Do I File a Claim?
If you’re submitting a claim for reimbursement, you’ll need to print off a Patient Request for Medical Payment form (CMS-1490S). You can fill it ou...
Why would I need to file a claim?
As we mentioned, you may not need to file a claim if you’re on Medicare. Most of your claims will be filed for you if you’re on Original Medicare,...
What do I need to include when mailing a reimbursement claim?
Along with the completed Patient Request for Medical Payment form, you’ll also need to include:
Can I Submit a Claim Directly to Medicare If I Have Medicare Advantage?
No — if you have Medicare Advantage, all coverage decisions are made by the private insurer you purchased your policy from. So, if you have a Medic...
What is the Railroad Medicare claims address?
If you receive retirement benefits and Medicare through the Railroad Retirement Board, your claims are handled by a separate Medicare Administrativ...
Railroad Retirement Board Benefits and Medicare | Eligibility
Due to COVID-19, the Railroad Retirement Board closed offices as of March 16, 2020. We’ll keep you updated on when offices reopen. In the meantime, visit RRB.gov to learn about your online self-serve options.
FREQUENTLY ASKED QUESTIONS BY RAILROAD MEDICARE
Q: I am unable to obtain any information from Medicare about my spouse’s claims. How can I obtain this information? A: In order to obtain this information, you must have a signed Beneficiary Authorization Form on file.
Railroad Healthcare Benefits Information - Retirement and Supplemental ...
Every employee’s situation can be unique. You must contact Customer Service at 1-800-842-5252 at least one month prior to retirement for information and questions, requests for GA-46000, and GA-23111 coverage books and COBRA FORMS.
Railroad Providers - Palmetto GBA
Top News Take Our Satisfaction Survey and See the Results You can give immediate feedback on your customer service experience with Railroad Medicare through our Provider Experience survey. We value your comments and opinions! By working together, we can elevate the level of service, education, information and transparency you have come to expect from Palmetto GBA. eServices Video Demo of Our ...
Provider Contact Center: 1-888-355-9165
Call the Provider Contact Center (PCC) to speak with representatives in Customer Service, Provider Enrollment, Electronic Data Interchange, eServices and Telephone Reopenings.
Interactive Voice Response (IVR): 1-877-288-7600
Use the IVR to request routine claim status, beneficiary eligibility, and payment information and to request a duplicate remittance advice.
Email Us
Use our contact form to submit general inquiries or to provide feedback on our website. For security reasons please do not submit requests involving PHI/PII with this form.
Contact Palmetto GBA Departments
For information on contacting a specific department by phone, email, fax, or for instructions on submitting documentation by mail, please select a department:
Feedback to the Railroad Retirement Board (RRB)
If you would like to send any feedback to the RRB regarding your experience with Palmetto GBA, please direct your comments to: [email protected] .
What information is needed for attachments for Medicare?
All attachments must identify the patient’s name, Medicare ID number, date of service and other pertinent information
When did Medicare stop making payments electronically?
Reminder: The Administrative Simplification and Compliance Act (ASCA) prohibits Medicare from making payments on claims not submitted electronically on or after October 16, 2003, unless a provider is small (fewer than 10 full-time equivalent employees for providers required to bill Medicare carriers) or meets one of the very few limited exceptions to this requirement.
What is the CMS 1500 form?
The CMS-1500 claim form answers the needs of many insurers. It is the basic form prescribed by the Centers of Medicare & Medicaid Services (CMS) for the Medicare program for claims from physicians and suppliers. The revised version of the CMS 1500 claim form is version and is approved under the OMB control number 0938-1197.
How many service lines are required for a CMS 1500?
More than six service lines per CMS-1500 claim form. Do not compress two lines of information on one line. If more than six service lines are required, see instructions listed below under "Claims Submitted with Multiple Pages."
Can a CMS 1500 claim be scanned?
If multiple CMS-1500 claim forms are submitted with totals on each claim form, the claims will be scanned as separate claims and not as multi-page claim.
Do you list other supplemental coverage in item 9?
Do not list other supplemental coverage in Item 9 and its subdivisions at the time a Medicare claim is filed. Other supplemental claims are forwarded automatically to the private insurer if the private insurer contracts with the carrier to send Medicare claim information electronically.
Can you submit paper claims electronically?
Even if you qualify to submit paper claims, consider submitting electronically.
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 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
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.
What is the form called for medical payment?
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.
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 is the phone number for Medicare?
Beneficiaries should call 1.800.MEDICARE (1.800.633.4227) for assistance with questions about the competitive bidding program or claims.
What to state in written inquiries?
Written Inquiries: Please state your question or concern as clearly as possible, including all pertinent information:
License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition
Enter your ANSI denial code from your RA into the Claim Denial Resolution Tool to view details and access education to help you resolve the claim.
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File a complaint (grievance)
Find out how to file a complaint (also called a "grievance") if you have a concern about the quality of care or other services you get from a Medicare provider. Contact your State Health Insurance Assistance Program (SHIP) for local, personalized Medicare counseling.
File a claim
Get information on how and when to file a claim for your Medicare bills (sometimes called "Medicare billing"). You should only need to file a claim in very rare cases.
Check the status of a claim
Check your claim status with your secure Medicare account, your Medicare Summary Notice (MSN), your Explanation of Benefits (EOB), Medicare's Blue Button, or contact your plan.
File an appeal
How to appeal a coverage or payment decision made by Medicare, your health plan, drug plan or Medicare Medical Savings Account (MSA) Plan.
Your right to a fast appeal
Learn how to get a fast appeal for Medicare-covered services you get that are about to stop.
Authorization to Disclose Personal Health Information
Access a form so that someone who helps you with your Medicare can get information on your behalf.
Who is in charge of Medicare?
CMS is the agency in charge of the Medicare program. The Railroad Retirement Board (RRB) enrolls railroad retirement beneficiaries in the program, deducts Medicare premiums from monthly benefit payments, and assists in certain other ways.
What is Medicare Part A?
Hospital Insurance ( Medicare Part A ), which helps pay for inpatient care in hospitals and skilled nursing facilities (following a hospital stay), some home health care services, and hospice care.
What is the enrollment period for Medicare?
Special Enrollment Period for People Covered Under a Group Health Plan#N#If you are age 65 or older and covered under a group health plan, either from your own or your spouse’s current employment, you have a special enrollment period in which to sign up for Medicare Part B. This means that you may delay enrolling in Medicare Part B without having to wait for a general enrollment period and paying the 10 percent premium surcharge for late enrollment. The special enrollment period rules allow you to: 1 enroll in Medicare Part B anytime while you are covered under the group health plan based on current employment; or 2 enroll in Medicare Part B during the 8-month period that begins the month after your group health coverage ends or employment ends, whichever comes first.
How long do you have to be on Medicare to get free medical insurance?
If you are under age 65.-- Before age 65, you are eligible for free Medicare hospital insurance if you have been entitled to monthly benefits based on a total disability for at least 24 months and have a disability insured status under social security law. If you are entitled to monthly benefits based on an occupational disability, and have been granted a disability freeze, you are eligible for Medicare starting with the 30th month after the freeze date or, if later, the 25th month after you became entitled to monthly benefits. If you receive benefits due to occupational disability and have not been granted a disability freeze, you are generally eligible for Medicare hospital insurance at age 65. (The standards for a disability freeze determination follow social security law and are comparable to the medical criteria for granting total disability.) You are also eligible for Medicare if you have Lou Gehrig’s disease (amyotrophic lateral sclerosis).
What age does Medicare cover?
Medicare is our country’s health insurance program for people age 65 or older, certain people with disabilities who are under age 65, and people of any age who have permanent kidney failure.
When does Medicare Part B become effective?
When does your enrollment in Part B become effective? If you accept the automatic enrollment in Medicare Part B, or if you enroll in Medicare Part B during the first 3 months of your initial enrollment period , your medical insurance protection will start with the month you are first eligible. If you enroll during the last 4 months, your protection will start from 1 to 3 months after you enroll.
Does Medicare cover railroad workers?
The Medicare program covers railroad workers just like workers under social security. Railroad retirement payroll taxes include a Medicare hospital insurance tax just like social security payroll taxes. Though you’re paying into the Medicare program during your working years, and will probably rely on its services in the future, ...
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.
What Do I Submit with The 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 subm…
Where Do I Send The Claim?
- The address for where to send your claim can be found in 2 places: 1. On the second page of the instructions for the type of claim you’re filing (listed above under "How do I file a claim?"). 2. On your "Medicare Summary Notice" (MSN). You can also log into your Medicare accountto sign up to get your MSNs electronically and view or download them an...