1. Fill out the Personal Information Form. Please fill in as much information as you possibly can. You will note there are several spaces for insurance. The first line (#1) is for the Medicare number, which will be on your Medicare card, if you are eligible and are enrolled in Medicare. If you are not eligible for Medicare, then your primary insurance will go in the #2 line. The Supplemental insurance policies or any other policies you may have including nursing home policies will go in line #3.
2. You will need to fill out and sign the Medical Claims Service Authorization to Release Information form, the Authorization letter, and the Paper Disposal request. One signed copy of the Medicare Part B Request for Release of Information also needs to be signed by the individual if enrolled in Medicare. If the individual is unable to sign that form, then have them place an "X" on the signature line and have two witnesses sign the form.
3. Please send all Medicare Explanation of Benefits, Primary and Supplemental Insurance Explanations of Benefits, and copies of all medical and hospital bills and prescription statements to the address above. If you want us to track payments made to nursing homes or assisted living homes, please send us copies of the monthly statements. We will need to receive these on a routine basis in order to best service your needs. You also need to provide a photocopy of the front and back of all insurance cards, including Medicare if you have it. We furnish you with mailing labels, so when you run low, please let us know.
4. We will tell you which bills should be paid. Please mark "PAID" on any statement if it is paid by you, before sending it to us. If Medicare or other insurance has sent a check to you, please let us know if you have cashed the check or if you have endorsed it over to the provider. We prefer you not pay any bills unless we tell you to. Pharmacy bills are usually the exception.
If you have any questions regarding these forms, please give us a call.
Medical Claims Service