Medicare Claims and Appeals in Arizona


Filing an Arizona Medicare claim should normally be a rare event, but when you need to get it done, you should be ready to do so quickly and efficiently. A Medicare claim form can come in a few different configurations. While this article will discuss all of them, it will focus mainly on the Medicare claim forms that deal with requesting medical payment from Medicare for services that you believe should be covered under your current plan. This article will also discuss how to file a Medicare claim online for the four different Medicare plans, and how to check the status of your Medicare claims as they are being processed.

Medicare Claim Types in Arizona

Arizona Medicare claims can be categorized in different ways. As a Medicare recipient, you want to make sure that you use the correct Medicare claim form for your specific problem. A Medicare claim can really be broken into two main categories: general claims and appeals. A general Medicare claim is usually filed by doctors or suppliers and sent to Medicare when they have provided you with Medicare-covered services. Usually, these Medicare claim forms are only submitted by physicians. However, there are occasions where Medicare recipients will need to file a claim on their own. Because AZ Medicare claims can only be filed up to one year after the service has been provided, doctors will occasionally forget to file these claims. While you should always contact your doctor first in this situation, they may still neglect to file your claim on time. Only then should you consider filing a Medicare claim form as outlined below.

The second type of Medicare claim, an appeal, is more of an objection. A Medicare appeal is used when a Medicare recipient takes issue with their Medicare coverage plan not covering a specific service or prescription that he or she believes should be covered. Medicare appeals can also be submitted when a beneficiary wishes to change the amount of money he or she has to pay for a health care service, or when he or she would like to receive payment from Medicare for a service he or she has already received. This type of AZ Medicare claim appeal is usually made of five different levels, where a Medicare recipient can move along the Medicare appeals process (i.e. at one end, Level 1 is appealing to Medicare itself, while at the other end, Level 5 is appealing to a judicial review by a federal district court). If the recipient disagrees with the verdict of any level, he or she can move the Arizona Medicare claim process on to the next level.

How and When to File a Medicare Claim Form in Arizona

Medicare claims in Arizona can have many different parts, but they are very important to complete if you feel like your Medicare coverage is incorrect or insufficient in any way. Filling out your Medicare claim online is possible, but you can also print, complete and send in your forms to Medicare via mail. Make sure that the Medicare claim that you are filing for is for a claim no older than 12 months old, as Medicare cannot process claims for services which occurred more than a year ago.

What kind of Medicare claim form you need to fill out depends mostly on what kind of Medicare coverage you have (and are filing the claim against). There is a unique Medicare claim form to complete if you are under Original Medicare (Part A and B), but if you have Medicare Part C or Medicare Part D and are requesting a Medicare claim review for one of those plans, you will need to contact your plan directly to receive the proper documentation to fill out. In almost every Medicare claim, however, you must usually include the following information:

  • The completed Medicare claim form appropriate for your coverage

  • The itemized bill from yourself, your doctor or health care provider indicating what the claim is being filed to address

  • A detailed letter explaining your reason for filing the Medicare claim

  • Any other documents that you have collected to make your verify your claim

For detailed instructions on how/where to fill out these Medicare forms, along with links to convenient resources, please download our comprehensive guide here.

How to Check Medicare Claim Status in Arizona

You can check a Medicare claim status in Arizona using a few different methods. There are two ways to check Medicare claim status for Parts A and B using the Medicare website. Alternatively, you can check your Medicare Summary Notice (MSN), which you should be receiving in the mail every three months.

To check your Part D Medicare claim status in AZ, most of these same methods apply. However, instead of appearing on your MSN, your Part D drug plan will mail you an Explanation of Benefits, which will summarize your plan and claim. Checking Part C Medicare claims require you to contact your plan provider. For more detailed information about checking your Medicaid claim status, download our complimentary guide today.

Who Is Eligible to Get Health Services in Arizona?

Residents must meet the eligibility requirements established by the Arizona Health Services Department in order to quality for programs such as Medicaid and Medicare. Your income and age might be significant factors regarding your eligibility, but requirements vary. To learn more about AZ medical assistance, download our guide today.

What Kinds of Health Care Services Can I Receive in Arizona?

Arizona health care services differ significantly in regards to price and coverage. A resident’s eligibility might also play a role in the cost of each service. To learn about how you can apply for these health services, please download our guide now.