Beneficiary Claims

Both Medicare providers and beneficiaries can submit claims to the Medicare Pilot Program for Asbestos Related Disease for processing by Noridian. Claims processed by Noridian will not be forwarded to the pilot program.

How do I Submit Claims for Payment?

When a Medicare claim is denied or reduced by a Medicare Contractor or another insurance company, the claim must be submitted to Noridian for consideration under the pilot program. Either the provider of the claim services or beneficiary can submit this pilot claim to Noridian.

Below are instructions for beneficiaries to use when submitting claims to the pilot program:

Mail or fax the following information to the address or fax number below:

  • A completed CMS 1490-S “Patient’s Request for Medicare Payment” found at: . If needed, this claim form can be mailed to you. Instructions for completion are on Page 2 of the form.
  • Corresponding medical records
    Examples: Physician notes, prescriptions/orders, Certificates of Medical Necessity (CMN) for Durable Medical Equipment, if applicable
  • A copy of the Medicare Summary Notice (MSN) showing the items or services provided
  • If Medicare didn’t process the claim, include copies of a receipt or other documentation describing the items or services and the amount you paid.

Claims Mailing Address and Fax

PO Box 6761
Fargo ND 58108-6761

Fax: 1-866-352-6158

Note: If the provider is not enrolled in Medicare, the beneficiary must submit the claim.

You will be notified in writing of the payment decision by an Explanation of Benefits which will be mailed to you.

Get Help Submitting a Claim

For help submitting a claim, call Noridian at 1-888-469-9464, between 8 am-3 pm MT.

How long do I have to file a claim?

Claims must be submitted within one calendar year from the date of service.

What if My Pilot Claim Was Denied?

If your claim for coverage under the Medicare Pilot Program for Asbestos Related Disease was denied, you can appeal, and ask for a second look at the claim. You must appeal within 120 calendar days from the date on the pilot Explanation of Benefits (EOB). See the Beneficiary Appeal section of this web site for more information.