How to Check Medicare Claims in Pennsylvania

Medicare is a federally funded health insurance program for individuals over 65 or those under 65 with a qualifying health condition. Medicare provides comprehensive coverage including hospitalization, doctors' visits, medical procedures and prescription drugs. Management of Medicare is by the Centers for Medicare & Medicaid Services, which maintains 10 regional offices, including one in Philadelphia. The program is available to qualified Pennsylvania residents, and they can check claims status through a variety of methods.

Things You'll Need

• Medicare ID number
• Claim date of service or claim number

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Instructions

• 1

  Review the Medicare Summary Notice sent in the mail that shows a summary of the past three months of claims history. This notice details each claim, showing all doctors' visits, medical procedures and supplies sent for claims reimbursement. It lists what was paid to providers and the total you may owe to each.

• 2

  Go to MyMedicare.gov. and create an account and log in. Once on the site, select the "Search Claims" feature to search claims by number, claim type or date of service. You can also review the Medicare Summary Notices on MyMedicare.gov. Claims are usually viewable 24 hours after Medicare processing.

• 3

  Call your provider to check and see if they have submitted claims to Medicare and received any reimbursement. The billing specialist at your provider's office or the hospital can walk you through what was submitted, when and for how much.

• 4

  Contact Medicare at 800-633-4227 to check on your Medicare claims. A representative can provide you with information about your claims or direct you to where you can find more information.

• 5

  Contact a representative at the Pennsylvania Insurance Department. Residents can call 877-881-6388 or email them at [email protected] for assistance with Medicare claims and other health insurance questions.

• 6

  Call your local Medicare contractor if you are a health care provider or authorized billing service to check on a patient's claims status. If you have the appropriate software, you can submit a Health Care Claim Status Request (276 transaction) electronically and Medicare will send back a Health Care Claim Status Response (277 transaction). The software vendor that administers the Medicare software will be able to help you with this.