How to Fill Out a Medicaid Claim Form

Medicaid is a state-operated health insurance program that must follow federal guidelines. The federal government provides some of the funding for state Medicaid programs. Filling out a Medicaid claim form is necessary for medical providers and for individuals when certain medical services are not covered or the provider does not submit a claim to Medicaid.

Things You'll Need

• Medicaid number or Medicaid card
• Service code(s) and medical provider number

Show More

Instructions

• 1

  Obtain necessary Medicaid claim forms from your local or state Medicaid office. These forms have different names depending on the state in which you are filing the claim.

• 2

  Contact your medical provider and/or state Medicaid office to obtain specific information for the form. Your state Medicaid office will be able to instruct you on the exact service codes to enter on the form. In many cases, a provider number must be entered.

• 3

  Contact your state Medicaid office and submit the form to the address stated by the Medicaid office. This varies between each individual state. Submitting Medicaid claims electronically or via fax may also be an option.