Medicaid is a state-operated, federally- and state-funded medical program for low-income elderly or disabled individuals, pregnant women and children. A claim must be submitted to Medicaid for your medical expenses to be paid by the program.
Contact your state's Medicaid office to obtain a copy of the state-specific claim form and submission instructions. The National Association of State Medicaid Directors maintains a list of contact information for each state's Medicaid program (see Resources).
Obtain the HCPCS code for your medical services or supplies that you want reimbursement for. If you are unsure of which code to use, you may contact 800-MEDICARE to obtain the service code.
Obtain the name, address, phone number and National Provider Identifier (NPI) for the provider of service and write this information in the blanks. If you are a patient completing the claim, you will need to contact the medical provider directly to obtain the NPI.
Fill out the patient information on the claim form. You will need the patient's name, address, date of birth, Social Security number, Medicaid number and a listing of medical diagnoses that the service or supply was used to treat. If you are unsure of the Medicaid number, you may contact the state's Medicaid office to obtain this number.
Submit the claim form per the instructions provided by the state's Medicaid office. In many cases, you may be able to submit the claim electronically. Otherwise, you will need to fax or mail the claim form to the state's Medicaid claim processing unit.
- Centers for Medicare & Medicaid Services: HCPCS Release & Code Sets
- Medicaid.gov. "Program History." Accessed August 3, 2020.
- Medicare.gov. "Skilled Nursing Facility (SNF) Care." Accessed August 3, 2020.
- Medicare Advantage. "The 5 Qualities Shared by Top Medicare Supplement Insurance Companies." Accessed August 3, 2020.
- Medicare.gov. "Medicare Advantage Plans cover all Medicare services." Accessed August 3, 2020.
- Medicaid.gov. "Eligibility." Accessed August 3, 2020.
- MSLegalServices.org. "Medicaid." Accessed August 3, 2020.
- New York State Department of Health. “Medicaid in New York State.” August 3, 2020.
- U.S. Department of Health and Human Services. "Financial Requirements - Assets." Accessed August 3, 2020.
- American Council on Aging. "How to Spend Down Income and/or Assets to Become Medicaid Eligible." Accessed August 3, 2020.
- American Council on Aging. “Medicaid Coverage of Nursing Home Care | When, Where and How Much They Pay.” August 3, 2020.
- Centers for Medicare and Medicaid Services. "Important Facts for State Policymakers: Deficit Reduction Act," Pages 1-2. Accessed August 3, 2020.
- Centers for Medicare and Medicaid Services. "Important Facts for State Policymakers: Deficit Reduction Act." Accessed August 3, 2020.
- Medicaid.gov. “Estate Recovery.” Accessed August 3, 2020.
Matt Knouff is a mental health professional, programmer and freelance writer from Lafayette, Ind. His educational background includes a bachelor's degree in psychology and anthropology from Purdue University and undergraduate certificates in computer science and music production. He has been writing professionally for three years and currently writes for TopTenReviews.com and other online publications.