Filing a Claim to Railroad Medicare: Using the Railroad Retirement "Patient's Request for Medicare Payment" (G-740S) Form
By law, doctors and suppliers who participate in Medicare are required to file Medicare claims for covered services. Beneficiaries should file a claim to Medicare only in rare circumstances, such as if the provider or supplier refuses to file a claim, you are filing for a Medicare non-covered service and need to show the denial so you can submit to your secondary insurance, or the service was provided outside the United States and its territories. All claims must be received by Medicare within 12 months from the date the service was provided.
If you need to submit a claim to Railroad Medicare, you must complete a G-740S Form (PDF, 193 KB) and attach an itemized bill from your Medicare-enrolled provider. It’s important to note that your bill does not have to be paid before you submit the claim form, but you must attach an itemized bill in order for Medicare to process your claim for consideration. The itemized bill must contain the provider's name and address. You must also attach a statement explaining why your provider is not submitting a claim for you.
The claim form should include the following:
- Patient’s name and address
- Patient’s Medicare number (exactly as it appears on the Railroad Medicare card)
- Patient’s gender (male or female)
- Description of the service(s) received
- Patient’s signature
The itemized bill should include the following:
- Doctor or Provider’s name, address and National Provider Identifier (NPI) number
- Place of service
- Description of illness or injury
- Date of service for each service received
- Description of each service received
- Amount charged for each service received
Please remember that the claim form must be received at Railroad Medicare within 12 months from the date the service was provided. Then allow Railroad Medicare 60 days to receive and process your claim.
Completed claims should be returned to:
Palmetto GBA Railroad Medicare
P.O. Box 10066
Augusta, GA 30999
For more help, please call us at 800-833-4455, between 8:30 a.m. and 7 p.m. ET. Basic Medicare information for providers may be found on our website at www.PalmettoGBA.com/rr. We encourage you to visit our Facebook page called 'My RR Medicare' at www.facebook.com/MyRRMedicare.