Overview of Medicare Appeal, Claim, Disclosure and Application Forms

medicare appeals

In case you didn’t already know there are several types of Medicare insurance forms, and they are available online so you can file them electronically or mail them in.

“Medicare has made the process of completing and submitting forms easy,” notes Alan Weinstock, insurance broker at MedicareSupplementPlans.com, “by offering the Medicare application, claim forms for patients requesting payments and Medicare appeal forms all online. Even if your claim has been denied by Medicare, appeal forms can be submitted online requesting a hearing or case review.”

There are four online Medicare forms available for your use:

1. Medical Authorization to Disclose Personal Health Information

2. Online Medicare Application

3. Patient’s Request for Medical Payment

4. Medicare Appeals Form

The Authorization form allows the Center for Medicare and Medicaid Services (CMS) to disclose personal health information to persons or organizations that you designate. The Medicare application is to be used to sign up for Medicare if you are at least 64 years and 8 months old. The other two forms are discussed below.

Online Forms for Appealing a Medicare Insurance Denial

There are five forms used to appeal an unfavorable Medicare decision. Each of these forms should be used when escalating an appeal for Medicare denial. The appropriate form depends on the situation and the stage of the appeal.

If you were denied Medicare, you can appeal using an attorney who specializes in disability and Medicare rules.

However, you can appeal directly as well. There are Medicare appeal forms to:

1. Appoint someone (such as an attorney) to represent you (CMS 1696)

2. Transfer your appeal rights to your provider or supplier (CMS 20031)

3. Request a hearing (CMS 20027)

4. Ask for a case review when you’re dissatisfied with the results of a hearing (CMS 20033)

5. Request a final review if dissatisfied with the case review (CMS 20034 A/B)

Online Medicare Insurance Claim Forms

One of the benefits of online Medicare forms is that you can directly submit a request for payment of medical expenses. If you see a health care provider who is not enrolled as a Medicare provider or who refuses to submit claims, use form CMS 1490S to request payment from Medicare directly. You need to do this within one year from the time of service.

To submit a claim form you should:

1. Print the form from the Medicare.gov site

2. Fill in the form and submit it along with copies of your bills or other documentation (hang onto your originals for your files)

3. If you want Medicare to give your personal health information to someone other than you, submit a completed Authorization to Disclose Personal Health Information form

4. Explain why the bill is being submitted (i.e. “provider refused to submit bill”)

5. Mail in the form to the state address where services were provided

6. Allow 60 days for Medicare to complete payment process

By the way, if you are unable to find the National Provider Identifier (NPI) number, the Medicare contractor will look this up when processing your claim form.

All forms are accessible for view, print, download and submission from the CMS forms catalog or can be requested from Medicare by telephone at (800) 633-4227.