HI 00630.160 Inquiries Requesting Payment or Claims Assistance Relating to Medicare Services Furnished in the United States

A. Claimant is in the U.S., Canada, or Mexico

Refer the inquiry to the district office and notify the claimant of the referral (use form SSA-L526F), after making photocopies of the material to be referred for the folder. No further action or control is necessary.

B. Claimant is not in the U.S., Canada, or Mexico—CDB development

If only HI is involved, advise the claimant to contact the provider; i.e., hospital, extended care facility, or Home Health Agency, which furnished the services. The provider will advise the claimant whether the services were covered and help him file a claim. Advise the claimant of his claim number and tell him he must give this number to the provider. Any bills or receipts submitted should be returned to the claimant so that he can forward them to the provider.

If an HI card was not issued to the claimant, institute procedures to have one issued whether or not the claimant has asked for a card. The reply to the claimant should not be delayed pending receipt of the card since the claim number is all the provider needs to know.

Where SMI is involved examine the file to see whether or not it appears the claimant will need assistance in filing his claim. If it appears he will, request the appropriate Foreign Service post to provide it. The originals of any bills or receipts submitted by the claimant should be enclosed with the request to the FSP or VARO after making copies for the folder. A copy of the Medicare handbook and Form CMS 1490S, Request for Medicare Payment, should also be enclosed with the request to the FSP. The FSP should be asked to help the claimant complete and mail the CMS 1490S. Advise the FSP that the instructions for completion are found on the back of the form and the name and address of the carrier handling medical insurance claims for the area in which the services were furnished can be found in the handbook. If HIB is also involved, advise the FSP that the claimant must write to the provider about his hospital insurance claim and that only those bills and receipts having to do with medical insurance should be sent to the medical insurance carrier. Any bills or receipts having to do with hospital insurance should be sent to the provider.

Where it appears the claimant can follow through on his own or has a competent person helping him, send a CMS 1490S and a handbook if it appears he does not have one. (All inquiries received from the Philippines should be referred to VARO.) Advise the claimant to complete the form according to the instructions on the back of the form being sure to show his claim number on the form and on each bill. If the proper carrier can be determined, give the claimant the name and address. Otherwise, refer the claimant to the appropriate pages of the handbook. Supply any technical advice that seems appropriate. If HI is also involved, advise the claimant to write to the provider about his hospital insurance claim and that only those bills and receipts having to do with medical insurance should be sent to the medical insurance carrier. After photocopying, the originals of any bills or receipts submitted by the claimant should be returned to him.

No control is nece