How to Submit Claims to Medicaid

Medicaid is a health insurance program for low-income individuals that is operated by each state's government. A claim form must be submitted for reimbursement of any medical expense covered by Medicaid, including prescriptions, routine doctor appointments and emergency room visits. The medical provider or the recipient of services may submit claims. In cases where a provider does not submit a Medicaid claim on your behalf, you are required to submit the claim to receive reimbursement.

Instructions

• 1

  Contact your state's Medicaid office. The National Association of State Medicaid Directors' website offers contact information for each state's Medicaid office (see Resources). Inquire which form you will need to submit your claim and the exact process for submitting it. Forms and exact procedures vary among states.

• 2

  Gather receipts for all your medical expenses for which you want reimbursement. These receipts should clearly state the medical expense and the provider of the medical product or service. Medicaid provides reimbursement for routine doctor visits, prescription drugs, medical equipment (such as diabetic testing supplies and power chairs), medical services received from a specialist and mental health services (such as case management, individual therapy and partial hospitalization).

• 3

  Complete each form necessary for filing a Medicaid claim in your state. You will need your Medicaid number, identifying information (such as your full name, address, date of birth and Social Security number), a provider identification number and the service code, which identifies the type of medical service you received.

• 4

  Submit the claim with your receipts to the mailing address or fax number listed on the claim form. Wait 15 to 45 days to receive a response. Your claim will be reviewed by your state's Medicaid claim processing unit to determine if the service or product is eligible for reimbursement. The data on the form will also be verified. If the form is completed incorrectly, it will be returned to you with a list of reasons for the rejection. You may then resubmit it with corrected information.