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Printed Date: 9/22/2015
Railroad Medicare organizes its forms based on subjects. If you are new to our website, select Medicare Forms in our Tools button on the toolbar across the top of this page. This will open our Forms page which contains two options: "Know the form you need?" and "Which area is your inquiry related to?"
When you choose "Know the form you need? View the full form list" you will be directed to a list of all Railroad Medicare forms sorted by area/subject. Once you locate the form you need, click on the form name to open the PDF form. You can fill out the form online before printing and sending it to Railroad Medicare by fax or mail.
When you choose an area under "Which area is your inquiry related to?" you will be directed to a "decision tree," which asks a few short questions and leads you to the form you need.
Note: Forms may change! Please make sure you bookmark the Forms page instead of an individual form, and come back each time you need a form. If you do not submit the correct form your request may be delayed or denied.
Many forms are also available as paperless eForms on our eServices provider internet portal. Not an eServices user yet? Sign up today to take advantage of online form submissions and the other time saving eServices features.
You can participate in eServices if you have a signed electronic data interchange (EDI) Enrollment Agreement on file with Palmetto GBA. If you are already submitting claims electronically, you do not have to submit a new EDI Enrollment Agreement. See the Access eServices section of our website for more information.
Instructions for submitting a form in eServices can be found in the eServices User Manual (PDF, 8.13 MB).
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Last Updated: 06/02/2020