Medicare claim address, phone numbers, payor id – revised list
| State | State | IVR # | Claim mailing address | Appeal address |
| Wyoming | WY | 1-877-908-8431 | Medicare Part B P.O. Box 6708 Fargo, ND ... | Medicare Part B PO Box 6708 Fargo, ND 58 ... |
| Virginia | VA | 1877-872-5556 | Palmetto GBA – J11 MAC Mail Code: AG-600 ... | Palmetto GBA – J11 MAC Mail Code: AG-600 ... |
| West Virginia | WV | 1877-872-5556 | Palmetto GBA – J11 MAC Mail Code: AG-600 ... | Palmetto GBA – J11 MAC Mail Code: AG-600 ... |
| Idaho | ID | 1-866-502-9051 | CGS PO Box 22599 Nashville, TN 37202 | CGS Attention: Redeterminations PO Box 2 ... |
Full Answer
How to properly compose Medicare appeal letter and its sample?
Sample Appeal Letter A. Please accept this letter as [patient's name] appeal to [insurance company name] decision to deny coverage for [state the name of the specific procedure denied]. It is my understanding based on your letter of denial dated [insert date] that this procedure has been denied because: [quote the specific reason for the denial ...
Where do I send my appeal?
File an Appeal
- The appeal must be in writing or you may use form APL124F: Notice of Appeal/Board of Review
- You must appeal within 30 days of its issue. ...
- A party may inspect the file at the office of the Board during normal business hours by submitting a completed “Review File Request” (APL114F). ...
What are the levels of Medicare appeal?
There are five levels in the Medicare claims appeal process:
- Level 1: Your Health Plan. If you disagree with a Medicare coverage decision, you may request your health plan to redetermine your claim.
- Level 2: An Independent Organization. ...
- Level 3: Office of Medicare Hearings and Appeals (OMHA). ...
- Level 4: The Medicare Appeals Council. ...
- Level 5: Federal Court. ...
Where to file Medicare claims?
- Before filing claims electronically to Railroad Medicare, you must have an EDI enrollment packet on file with Palmetto GBA. ...
- View the Electronic Filing Instructions
- Palmetto GBA Interactive CMS-1500 Claim Form Instructions — This resource can also be helpful to providers who submit electronic claims. ...
What address do you send Medicare claims to?
Medicare claim address, phone numbers, payor id – revised listStateAppeal addressArizonaAZMedicare Part B PO Box 6704 Fargo, ND 58108-6704MontanaMTMedicare Part B PO Box 6735 Fargo, ND 58108-6735North DakotaNDMedicare Part B PO Box 6706 Fargo, ND 58108-6706South DakotaSDMedicare Part B PO Box 6707 Fargo, ND 58108-670719 more rows
How do I write a Medicare appeal letter?
Include this information in your written request:Your name, address, and the Medicare Number on your Medicare card [JPG]The items or services for which you're requesting a reconsideration, the dates of service, and the reason(s) why you're appealing.More items...
Can I submit paper claims to Medicare?
The Administrative Simplification Compliance Act (ASCA) requires that as of October 16, 2003, all initial Medicare claims be submitted electronically, except in limited situations. Medicare is prohibited from payment of claims submitted on a paper claim form that do not meet the limited exception criteria. web page.
How do I win a Medicare appeal?
Appeals with the best chances of winning are those where something was miscoded by a doctor or hospital, or where there is clear evidence that a doctor advised something and the patient followed that advice and then Medicare didn't agree with the doctor's recommendation.
How do I appeal my Medicare Part B premium?
First, you must request a reconsideration of the initial determination from the Social Security Administration. A request for reconsideration can be done orally by calling the SSA 1-800 number (800.772. 1213) as well as by writing to SSA.
Can I appeal a Medicare decision?
The plan must tell you, in writing, how to appeal. After you file an appeal, the plan will review its decision. Then, if your plan doesn't decide in your favor, the appeal is reviewed by an independent organization that works for Medicare, not for the plan.
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.
Where do I send Medicare Part B claims?
Mailing AddressesWho to WriteAddresses and Additional InformationAppealsClaimsJ15 — Part B/HHH Claims CGS Administrators, LLC PO Box 20019 Nashville, TN 37202Congressional InquiriesCGS Administrators, LLC J15 Part A/B Correspondence PO Box 20018 Nashville, TN 3720212 more rows
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.
What percentage of Medicare appeals are successful?
For the contracts we reviewed for 2014-16, beneficiaries and providers filed about 607,000 appeals for which denials were fully overturned and 42,000 appeals for which denials were partially overturned at the first level of appeal. This represents a 75 percent success rate (see exhibit 2).
What should I say in a Medicare appeal?
Explain in writing on your MSN why you disagree with the initial determination, or write it on a separate piece of paper along with your Medicare Number and attach it to your MSN. Include your name, phone number, and Medicare Number on your MSN. Include any other information you have about your appeal with your MSN.
How long does Medicare have to respond to an appeal?
How long your plan has to respond to your request depends on the type of request: Expedited (fast) request—72 hours. Standard service request—30 days. Payment request—60 days.
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...
What is an appeal in Medicare?
An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. For example, you can appeal if Medicare or your plan denies: • A request for a health care service, supply, item, or drug you think Medicare should cover. • A request for payment of a health care service, supply, item, ...
How to appeal Medicare summary notice?
If you have Original Medicare, start by looking at your " Medicare Summary Notice" (MSN). You must file your appeal by the date in the MSN. If you missed the deadline for appealing, you may still file an appeal and get a decision if you can show good cause for missing the deadline.
How long does Medicare take to respond to a request?
How long your plan has to respond to your request depends on the type of request: Expedited (fast) request—72 hours. Standard service request—30 calendar days. Payment request—60 calendar days. Learn more about appeals in a Medicare health plan.
How long does it take to appeal a Medicare denial?
You, your representative, or your doctor must ask for an appeal from your plan within 60 days from the date of the coverage determination. If you miss the deadline, you must provide ...
How long does it take for a Medicare plan to make a decision?
The plan must give you its decision within 72 hours if it determines, or your doctor tells your plan, that waiting for a standard decision may seriously jeopardize your life, health, or ability to regain maximum function. Learn more about appeals in a Medicare health plan.
How long does it take to get a decision from Medicare?
Any other information that may help your case. You’ll generally get a decision from the Medicare Administrative Contractor within 60 days after they get your request. If Medicare will cover the item (s) or service (s), it will be listed on your next MSN. Learn more about appeals in Original Medicare.
What to do if you decide to appeal a health insurance plan?
If you decide to appeal, ask your doctor, health care provider, or supplier for any information that may help your case. See your plan materials, or contact your plan for details about your appeal rights.
General Mailing Address
We encourage providers to send postal mail to the appropriate PO Box, but if you absolutely necessarily have to send Medicare documents via Priority mail or through a commercial courier (UPS, FedEx) for which a PO Box cannot be used, please use the following street address:
Qualified Independent Contractor (QIC) Reconsideration
Please use the following to submit requests for reconsiderations (second level appeals) to the QIC for Part A or Part B.
How long does it take to appeal a Medicare payment?
The MSN contains information about your appeal rights. You'll get a MSN in the mail every 3 months, and you must file your appeal within 120 days of the date you get the MSN.
Where to send redetermination request to Medicare?
Fill out a " Redetermination Request Form [PDF, 100 KB] " and send it to the Medicare contractor at the address listed on the MSN.
How long does it take for Medicare to be reconsidered?
You'll generally get a decision from the MAC (either in a letter or an MSN) called a "Medicare Redetermination Notice" within 60 days after they get your request. If you disagree with this decision, you have 180 days after you get the notice to request a reconsideration by a Qualified Independent Contractor (QIC).
What is a redetermination request?
The specific item (s) and/or service (s) for which you're requesting a redetermination and the specific date (s) of service. An explanation of why you don't agree with the initial determination. If you've appointed a representative, include the name of your representative.
Do you keep a copy of everything you send to Medicare?
Keep a copy of everything you send to Medicare as part of your appeal.
How to appeal a refund request?
If you are disputing a refund request, please send your letter of appeal to the address noted on the refund request letter. Your appeal must be received within thirty (30) calendar days of the date of the refund request letter, or as required by law or your participation agreement, in order to allow sufficient time for processing the appeal, and to avoid possible offset of the overpayment against future claim payments to you. When submitting the appeal, please attach a copy of the refund request letter and a detailed explanation of why you believe we have made the refund request in error.
Who completes the paper claim reconsideration form?
This form is to be completed by physicians, hospitals or other health care professionals for paper Claim Reconsideration Requests for our members.
What is a claim reconsideration request?
A Claim Reconsideration Request is typically the quickest way to address any concern you have with how we processed your claim. With a Claim Reconsideration Request, we review whether a claim was paid correctly, including if your provider information and/or contract are set up incorrectly in our system, which could result in the original claim being denied or reduced.
What is included in a paper claim?
2. Paper claims – include a copy of a screen print from your accounting software to show the date you submitted the claim.
How to reconsider a network provider claim?
Network Providers - Please check your fee schedules prior to submitting a claim reconsideration request for this reason. Indicate the contract amount expected by code or case rate, compared to the amount received, as well as other factors related to the over- or under-payment. If you disagree with the fee schedule your claim was paid by, contact your Network Management Representative. Go to and select your state to find the appropriate network management contact for your area.
What to do if bundled claim is not paid correctly?
If a bundled claim is not paid correctly, submit a detailed explanation including any pertinent information on why the bundling is incorrect.
What to do if you are not required to notify a customer service representative?
If you spoke to a customer service representative and were told that notification was not required, please submit the date, time and reference number of that call and the name of the representative handling the call. Please also advise if the service was performed on an emergency basis and therefore notification was not possible.
Who to send feedback to about CGS?
Send feedback to the Centers for Medicare & Medicaid Services (CMS) about your experiences with CGS:
Can you send PHI via email?
Note: DO NOT send Protected Health Information (PHI) or Personally Identifiable Information (PII) via email.
