Note: This section focuses on claims for original, fee-for-service Medicare. Claims for Medicare Part C – Medicare Advantage plans (including Medicare Health Maintenance Organizations – HMOs) and Medicare Part D – prescription drug plans are processed differently. Show OverviewYour 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. Medicare pays Part A claims (inpatient hospital care, inpatient skilled nursing facility care, skilled home health care and hospice care) directly to the facility or agency that provides the care. You are responsible for deductibles, copayments and non-covered services. Medicare pays Part B claims (doctors’ services, outpatient hospital care, outpatient physical and speech therapy, certain home health care, ambulance services, medical supplies and equipment) either to your provider or you. This is determined by assignment :
Medicare will send you a Medicare Summary Notice (MSN) form each quarter. For Medicare Part A claims,
For Medicare Part B claims,
Previously known as the Explanation of Medicare Benefits, the MSN is not a bill. You should not send money to Medicare after receiving an MSN. Your provider will bill you separately. back to top If You Have a Medigap (Supplemental Insurance) Policy or Retiree PlanYour Medigap (supplemental insurance) company or retiree plan receives claims for your services 1 of 3 ways:
Note: You may need to pay a provider bill before you get your quarterly MSN. In this case, check your MSN when you receive it to see if you overpaid. If so, call your provider to request a refund. If you have any questions about the bill, call your provider. You can also contact your local Health Insurance Counseling & Advocacy Program (HICAP) office online or at 1-800-434-0222. You will also receive an Explanation of Benefits (EOB) from your Medigap company or retiree plan. The EOB will show you how much was paid. If you don’t receive an EOB within 30 days of the service date, call your plan to ask about the status of your claim. back to top Calling About ClaimsFollow these pointers when you call to discuss your claims. Calling Medicare, Your Medigap Company or Retiree Plan
Calling Your Health Care Provider
Be sure to take notes, including the date and time of your call, the name of the person you spoke to, and the topics you discussed. Who processes Medicare claims in Florida?First Coast has proudly served as one of the nation's largest Medicare administrators for 50 years, and is the current Medicare Administrative Contractor (MAC) for Jurisdiction N (JN), which includes Florida, Puerto Rico and the U.S. Virgin Islands.
Where do I send Medicare claims in Illinois?Healthcare and Family Services.. Bureau of Professional and Ancillary Services.. Attn: Billing Consultant.. P.O. Box 19115.. Springfield, Illinois 62794-9115.. How do I contact my local Medicare office?1-800-MEDICARE (1-800-633-4227)
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