How to File a Medicare Claim Yourself When Your Provider Does Not Submit It
Learn when you can file your own Original Medicare claim using Form CMS-1490S, what documents to include, where to mail it and how to request reimbursement.
US United States
Benefits & Support ~ 11 min read
8 FAQ
Updated 2026-10-09
Helpydo structures practical guidance around official or public sources. For individual cases, confirm requirements with the responsible institution.
If your doctor or supplier does not file a claim for a service covered by Original Medicare, contact the provider first. If the claim remains unfiled, call 1-800-MEDICARE and use the Patient's Request for Medical Payment form (CMS-1490S) when appropriate. Mail the completed form, itemized bill, explanation and supporting records to the correct Medicare Administrative Contractor. Medicare claims generally must be filed within 12 months of the service date unless an exception applies.
What you need
- Completed Form CMS-1490S, Patient's Request for Medical Payment, including the beneficiary's Medicare number, personal information and signature.
- Itemized bill showing the date and place of service, description of the treatment or supply, individual charges and provider or supplier details.
- Written explanation of why the beneficiary is submitting the claim instead of the provider, such as refusal or inability to file.
- Relevant supporting records, including medical documentation when needed.
- Provider or supplier National Provider Identifier (NPI), if known, and ordering or referring provider information when required for the service.
- Primary insurer's Explanation of Benefits if Medicare is being asked to pay as secondary insurance.
- The correct Medicare Administrative Contractor mailing address for the claim type and applicable state or jurisdiction.
Eligibility
A person enrolled in Original Medicare may need to submit a claim personally in limited circumstances when a doctor, practitioner or supplier does not submit a claim for services or supplies that may be covered by Medicare. CMS Form CMS-1490S identifies situations in which the provider refuses to file, is unable to file or is not enrolled in Medicare.
Submitting the form does not establish that the service is covered or that reimbursement will be approved. Medicare may deny claims involving noncovered services or providers who are not enrolled in Medicare. Medicare Advantage and Part D claims generally follow the applicable health or drug plan's procedures rather than the Original Medicare CMS-1490S mailing route.
How to do it
- Check whether Medicare already received the claim. Review your Medicare Summary Notice or secure Medicare account. Confirm the date of service and provider.
- Ask the provider to submit the claim. Contact the doctor's office or supplier and request that it file the missing claim. Keep a record of the request.
- Contact Medicare if the claim remains missing. Call 1-800-MEDICARE (1-800-633-4227) to explain the situation and confirm the applicable filing deadline. TTY users can call 1-877-486-2048.
- Download Form CMS-1490S. Obtain the official Patient's Request for Medical Payment form and read the instructions for your claim type.
- Complete and sign the form. Enter your Medicare information, identify the reason for self-filing, describe the services and complete the insurance information where applicable.
- Attach the required evidence. Include the itemized provider bill, a letter explaining why you are filing and any supporting medical or insurance documents.
- Mail the claim to the correct contractor. Use the Medicare Administrative Contractor Address Table included with the official form. Make copies of the submission for your records.
- Check the outcome. Allow at least 60 days for receipt and processing, monitor your Medicare claim records and follow the instructions provided if additional information is requested or the claim is denied.
When can you file a Medicare claim yourself?
Under Original Medicare, doctors, providers and suppliers are generally required to submit claims for Medicare-covered services and supplies. Beneficiaries should need to file their own claims only in rare circumstances.
If your provider refuses to submit a claim, cannot submit it or is not enrolled in Medicare, you may need to use Form CMS-1490S, Patient's Request for Medical Payment. The form is administered by the Centers for Medicare & Medicaid Services (CMS), and completed claims are mailed to the appropriate Medicare Administrative Contractor (MAC).
Start by asking your provider to file the missing claim. If the provider still does not file, call 1-800-MEDICARE (1-800-633-4227) to discuss the problem and confirm the filing deadline. You can then obtain the official CMS-1490S form and instructions.
Original Medicare versus Medicare Advantage and Part D
Before completing a claim form, check which type of Medicare coverage was responsible for the service. The correct submission process depends on your coverage.
| Coverage | Usual claim route |
|---|---|
| Original Medicare Part B | Provider or supplier normally files; CMS-1490S may apply if it does not. |
| Medicare Advantage (Part C) | In-network providers usually file with the Medicare Advantage plan. |
| Standalone Medicare Part D | Pharmacy normally submits the claim to the drug plan. |
For a Medicare Advantage or Part D reimbursement problem, contact your plan for its claim submission instructions. Do not assume that mailing CMS-1490S to an Original Medicare contractor is the correct process for a plan-administered claim.
Medicare also explains that beneficiaries who paid out of pocket for certain covered vaccines or prescriptions may need to seek reimbursement through the applicable coverage process. The correct route depends on the service and plan.
What should you do before submitting a claim?
Receiving a medical bill does not necessarily mean your provider failed to submit a Medicare claim. You may have been billed for a deductible, coinsurance, a noncovered service or another amount for which you are responsible.
- Review the bill and identify the service date and provider.
- Check your Medicare Summary Notice (MSN) or secure Medicare account for the corresponding claim.
- Contact the provider's billing office and ask whether the claim was submitted.
- If the claim was not filed, request that the provider submit it to Medicare.
- If the provider refuses or does not act, contact Medicare before the filing deadline expires.
The official Medicare filing a claim guide explains these preliminary steps.
Why did your doctor send you a bill?
Medicare identifies several possible reasons for a bill: the provider does not accept assignment, has opted out of Medicare and entered into a private contract, furnished a service that Medicare does not cover, or is collecting a deductible or coinsurance amount.
Not every bill is evidence of a missing claim. If a provider has opted out of Medicare or the service is not covered, submitting CMS-1490S does not automatically create reimbursement eligibility.
How to complete Form CMS-1490S
The official form is called Patient's Request for Medical Payment (CMS-1490S). It covers specified Original Medicare claims, including Part B professional services and certain medical equipment and supplies.
Download the CMS-1490S English PDF and read the instructions before filling it out.
Choose why you are submitting the claim
The form provides three reasons for beneficiary submission. Select the applicable reason:
- The provider or supplier refused to file a claim for Medicare-covered services.
- The provider or supplier was unable to file the claim.
- The provider or supplier is not enrolled with Medicare.
If the provider is not enrolled in Medicare, reimbursement is not guaranteed. CMS warns that claims for services furnished by a non-enrolled provider may be denied.
Fill in the required sections
- Section 1 — Patient information: Enter your name as shown on your Medicare card, Medicare number, date of birth, address and telephone number.
- Section 2 — Services furnished: Describe the illness or injury and provide information about the services, including whether the condition involved employment or an accident.
- Section 3 — Other health insurance: Complete the applicable information about other coverage, including employer-related insurance and other insurers.
- Section 4 — Signature: Sign and date the form. Follow the special signature instructions if the beneficiary cannot sign personally.
If Medicare is secondary to another insurer, attach a copy of the primary insurer's Explanation of Benefits (EOB). For certain laboratory, imaging and durable medical equipment claims, the itemized bill must identify the ordering or referring provider as instructed on the form.
What documents must accompany CMS-1490S?
The itemized bill is essential. CMS states that Medicare cannot process the beneficiary claim without it.
Your itemized bill should identify:
- Date and place of service.
- Illness or injury associated with the treatment.
- Each medical service or supply furnished.
- Charge for each service or item.
- Doctor's or supplier's name and address.
- Provider or supplier National Provider Identifier (NPI), if known.
- Ordering or referring provider information when required.
Also include a short letter explaining why you are submitting the claim instead of the provider. Attach supporting medical records or insurance documents where relevant.
For example, if a physician provided a potentially Medicare-covered Part B service but refused to submit the claim, explain that refusal in your letter. Include the service date, itemized charges and provider information. Medicare will determine coverage and any payable amount after reviewing the submission.
What is the deadline to file your Medicare claim?
Medicare claims generally must be filed within 12 months, or one full calendar year, after the date of service, unless an applicable exception permits otherwise.
If the claim is not filed within the required period, Medicare generally will not pay its share. This deadline applies to the claim filing process, not to the date you received the provider's bill.
Do not wait until the end of the filing period to request the necessary documents. Medicare specifically advises beneficiaries to contact the provider and call 1-800-MEDICARE when a claim remains unfiled, especially as the deadline approaches.
If you believe an exception applies, ask Medicare to confirm the rule for your particular service. Do not assume that a late bill automatically extends the deadline.
Where do you mail the completed claim?
For Original Medicare, send the completed CMS-1490S form, itemized bill, explanation and supporting documents to the Medicare Administrative Contractor responsible for your claim.
The official CMS-1490S instructions include a Medicare Administrative Contractor Address Table. Mailing destinations vary by state, service type and contractor jurisdiction.
- Open the CMS-1490S form and mailing instructions.
- Locate the table matching your service type, such as Part B services or durable medical equipment.
- Find the applicable state or jurisdiction and copy the complete mailing address.
- Mail the completed form and supporting documents to that address.
- Retain copies of the signed form, bill and supporting records.
Do not send the claim to the general CMS headquarters address. The form explicitly warns that mailing claims to its administrative paperwork address can significantly delay processing.
If you cannot identify the correct contractor, call 1-800-MEDICARE. Medicare also explains that contractor information can be found through a previous Medicare Summary Notice or your secure Medicare account.
How long does Medicare take to process CMS-1490S?
The official CMS-1490S instructions say to allow at least 60 days for Medicare to receive and process the request.
This is an administrative instruction, not a guaranteed reimbursement deadline. Additional review or missing information may affect the outcome.
You can check your Medicare Summary Notice or secure Medicare account for claim activity. Contact 1-800-MEDICARE if you need help locating or understanding a submitted claim.
What happens if the claim is incomplete or denied?
CMS explains that when a beneficiary-submitted CMS-1490S contains incomplete or invalid information, the Medicare contractor returns the claim with a letter identifying the missing or incorrect details.
If that happens, follow the contractor's instructions, correct the identified information and provide the required documents. Pay attention to the original claim filing deadline and any instructions included with the returned claim.
A returned claim for missing information is different from a processed claim that Medicare denies. If Medicare makes a coverage or payment decision with which you disagree, the appropriate next step is generally the Medicare appeals process, not simply filing the same reimbursement request again.
Medicare's official claims guidance distinguishes filing a missing claim from appealing an unfavorable coverage or payment decision.
Important exceptions and reimbursement limits
- Non-enrolled providers: A claim may be denied when the service was furnished by a provider or supplier not enrolled in Medicare.
- Opted-out providers: A private contract with a provider who has opted out of Medicare can affect whether Medicare pays.
- Noncovered services: Self-filing does not make an excluded service eligible for Medicare payment.
- Special claim categories: CMS-1490S states that Medicare will not process beneficiary requests for payment for diabetic test strips, Part B drugs or items paid under the DMEPOS Competitive Bidding Program.
- Other insurance: If Medicare is secondary, additional insurance information and the primary insurer's EOB may be required.
- Deceased beneficiary: CMS instructs claimants to contact Social Security for guidance when the Medicare patient has died.
- Foreign or shipboard services: Medicare coverage is limited to specific circumstances and requires following the corresponding CMS-1490S instructions.
These distinctions matter because receiving a bill or paying out of pocket does not by itself establish Medicare coverage.
Where can you get help with your claim?
For help identifying the correct form, contractor or filing deadline, contact 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.
Medicare also identifies the State Health Insurance Assistance Program (SHIP) as a source of free, personalized Medicare counseling. The program can help beneficiaries understand their coverage and claims questions.
If the underlying problem is difficulty paying Medicare premiums or other Medicare-related costs, that is a separate assistance process. Depending on your circumstances, see the Helpydo guide to Medicare Savings Programs.
Official Medicare resources
- Medicare — Filing a Claim: explains when beneficiaries may file, required evidence and the filing deadline.
- CMS — Patient's Request for Medical Payment: official claim form and instructions.
- CMS — Form CMS-1490S PDF: form sections, evidence requirements, signature instructions and mailing addresses.
- Medicare — Other Forms: identifies the beneficiary claim form and where to send it.
Frequently asked questions
Can I submit a Medicare claim myself if my doctor refuses to file it?
Yes. For Original Medicare, beneficiaries may need to use Form CMS-1490S when a provider refuses or is unable to submit a claim. Contact the provider first and call 1-800-MEDICARE if the claim remains unfiled.
What Medicare form do I use to request reimbursement?
The official form is CMS-1490S, Patient's Request for Medical Payment. It is available from CMS and must be mailed with an itemized bill and relevant supporting documents to the correct Medicare Administrative Contractor.
How long do I have to file a Medicare claim myself?
Medicare claims generally must be filed within 12 months, or one full calendar year, after the date of service unless an exception applies. Call 1-800-MEDICARE to confirm the applicable deadline if your provider has not submitted the claim.
Can I get reimbursed if I already paid the doctor out of pocket?
You may be able to request Medicare payment if the service is covered and the provider failed or refused to submit the claim. Paying out of pocket does not guarantee reimbursement. Medicare determines the payable amount under its coverage and payment rules.
Where do I mail Medicare Form CMS-1490S?
Mail it to the Medicare Administrative Contractor identified in the address table included with the official form. The correct address depends on the state or jurisdiction and the type of service. Call 1-800-MEDICARE if you need help identifying the contractor.
How long does Medicare take to process a claim I mailed?
CMS instructs beneficiaries to allow at least 60 days for Medicare to receive and process a CMS-1490S claim. This is not a guaranteed decision or reimbursement deadline.
Can I use CMS-1490S for a Medicare Advantage claim?
CMS-1490S is the beneficiary claim form used for applicable Original Medicare claims. Medicare Advantage plans generally have their own claims processes. Contact your plan for the correct reimbursement instructions.
What if Medicare returns or denies my reimbursement claim?
If the form is incomplete or invalid, the Medicare contractor should return it with an explanation of what is missing. Correct the information according to the letter. If Medicare processes and denies the claim, review the decision and use the applicable Medicare appeals process if you disagree.
Official sources
Medicare — Filing a ClaimCMS — CMS-1490S Patient's Request for Medical PaymentCMS — Form CMS-1490S English PDF and InstructionsMedicare — Other FormsRelated procedures
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