Medicare Claims |
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 | We file Medicare claims on a non-assignment basis for products you purchase from us. |
| - On Non-Assignments Medicare reimburses the beneficiary directly.
- You pay up-front for non-assigned claims.
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| What kind of claims do we file for products on our website? |
| | Medicare | YES | | Medicaid | NO | | HMO's | NO | | Insurance | NO |
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| What products do we file Medicare claims for when purchased? |
| - Lift Chairs
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Walker and
Rollators
- Power Wheelchairs
- Power Scooters
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| What about Manual Wheelchairs and Hospital Beds ? |
| - Manual wheelchairs and hospital beds are "capped rentals" with Medicare. We do not Rent. This means that you should contact a local dealer/provider that rents equipment. Unfortunately, you don't have much choice of which equipment you will receive.
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| What about Bath products? |
| - Bath products are not covered by Medicare.
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| Non-Assignment - How we file Medicare claims: |
| We file Medicare claims for Internet sales on a non-assignment basis. Non-Assignment means that you pay for the product up-front. When filing on non-assignment, Medicare reimburses the beneficiary directly. You pay the full amount up-front. If you have secondary insurance you may contact them for filing procedures. In some cases Medicare automatically submits the claim to the secondary carrier.
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| How to start the claim process: |
| - You must have a Doctor's prescription for the product. We cannot do anything until we have the Rx. The Rx must be dated before the product is delivered.
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| Do you need a Certificate of Medical Necessity form (CMN) ? |
| - No. We will forward the CMN to your physician. Once the doctor completely fills out the CMN and returns it to us our billing department files an electronic claim with Medicare for you.
- You do not need to download the CMN from our website except to review it.
- Want to see the CMN for your product? Sure. Click here to download a CMN forms
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| Can you get pre-qualification with Medicare so you know if you will qualify for reimbursement? |
| - No, Medicare does not give prior approval except for high-end powered wheelchairs. If someone has told you otherwise, make the call to Medicare yourself, 1-800-MEDICARE
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| How long does it take Medicare to reimburse? |
| - Depends on which product. Some take a relatively short time while others take longer.
- Walkers, Rollators, and Lift Chairs are straightforward products that reimburse in a relatively short time (4-9 weeks).
- Some Power products such as Electric Wheelchairs and Scooters generally take longer.
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| What information do we need to file a Medicare claim? |
| Patient information: |
| - Patient's full legal name, address, phone number.
- Patient's date of birth.
- Patient's Medicare number (including the alpha character after the number).
- Patients height & weight.
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| Read PHC's Privacy Notice and HIPAA Compliance: |
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| Physician information: |
| - Doctor's Prescription for the product. The prescription should include the patient's diagnosis.
- Physician's name.
- Physician's address.
- Physician's telephone number.
- Physician's fax number.
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| The most common causes for delays in Medicare reimbursement. |
| - Doctor does not complete the required information on the CMN.
- Missing or inaccurate patient information.
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| How do you get the information to us? |
| - FAX or mail the information to us: 214-265-7817
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| Our mailing address: |
| PHC
attn: Medicare Processing
10362 Miller Rd
Dallas, TX 75238 | Medicare phone #: 214-265-7810 PHC Customer Service #: 214-265-7802 |
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| More on Medicare Basics. |
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| Still have questions? |
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