Medicare Claims |
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 | We file Medicare claims for most products you purchase from us on a non-assignment basis. |
| - On Non-Assignments Medicare reimburses the beneficiary directly.
- You pay up-front for non-assigned claims.
- We file assigned claims for Power Wheelchairs in certain areas of the US. Check areas served.
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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
- Walker and Rollators
- Power Wheelchairs
- Power Scooters
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| What about Manual Wheelchairs Hospital Beds and Patient Lifts? |
| - Manual wheelchairs, hospital beds and patient (Hoyer) lifts are Capped Rentals through Medicare. You must find a local dealer/provider that rents equipment. You will be limited to that suppliers product inventory.
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| What about Bath products? |
| - Bath products are not covered by Medicare. Coverage is limited to a Bedside Commode for patients that cannot make it to the bathroom by themselves. Shower chairs, stools, and transfer benches are not covered. Tub Lifts and Handicapped Showers are not covered.
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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 most 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
11601 Plano Rd, Suite 107
Dallas, TX 75243 | 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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