Guiding on Medicare claim cancellations, appeal processes, and additional steps
In most cases, individuals do not need to file a claim for Medicare as the medical professional takes care of this process. However, there are situations where a person may need to file a claim themselves.
If a person receives medical care outside the United States, they might need to file a claim for healthcare in another country, but coverage is only provided for specific circumstances such as a medical emergency in the United States, a medical emergency on a ship less than 6 hours from leaving or arriving at a United States port, or emergency treatment in Canada while traveling between Alaska and another state and taking a direct route through Canada.
In other scenarios, a person may have to file a Medicare claim if the medical professional does not accept Medicare, refuses to file a claim, or is unable to file a claim. If a medical professional refuses to file a claim, a person can file a complaint with Medicare through their State Health Insurance Assistance Program (SHIP) or by contacting Medicare and explaining why they would like to file a complaint.
To check the status of a Medicare claim, a person can review the claim in their Medicare account, contact the medical professional, or check their monthly Medicare summary notices for any outstanding claims. If a claim is denied, a person may decide to appeal within 120 days by completing a Redetermination Request Form (RRF) and sending it to the address in the appeals information section of the MSN.
It's important to note that there is no direct "cancel" option once a claim is submitted. Instead, inaccurate or unwanted claims are addressed through corrected claims or appeals. The appeal process can be used if you disagree with a payment denial, and typically you have 120 days after receiving your Medicare Summary Notice to file an appeal for original Medicare claims (Parts A and B).
The process of filing a Medicare claim involves contacting Medicare, completing a form (CMS-1490S), providing an itemized bill, and including supporting documents such as medical history or referrals. The Centers for Medicare & Medicaid Services (CMS) describes the steps for filing a Medicare complaint on Medicare.gov.
When it comes to Part A (Hospital Insurance), self-filed claims must be corrected or appealed following the same timelines as outlined above. If discharged from the hospital and you disagree with billing, a fast appeal can be requested on the discharge day, per the patient rights notice. No direct cancellation is possible; only corrections or appeals are allowed.
For Part B (Medical Insurance), claims for physician services or outpatient care can be corrected by submitting a corrected claim (with original claim number and frequency code). Appeals are available within 120 days after receiving the Medicare Summary Notice if denied.
For Part C (Medicare Advantage) and Part D (Prescription Drug Plans), the process is slightly different as Medicare Advantage plans have their own claim filing procedures handled through the plan. Claim cancellations or reversals usually require contacting the plan directly.
When resubmitting or correcting a claim, it's essential to include the original claim number, corrected information, the correct claim frequency code, and a reason for the correction or appeal, along with any supporting documentation if needed.
In summary, while there is no direct way to "cancel" a self-filed Medicare claim once accepted into the system, the claim can be either corrected with updated information or appealed if denied. If you want to stop payment or correct a problem, resubmission or appeal is the standard route.
If you need to update personal/provider information related to claims or profiles, CMS recommends updates via the PECOS system or contacting the Quality Payment Program as relevant. This guide provides an overview of the current claims instructions as of mid-2025.
- If a person receives medical care outside the United States, they might need to file a claim for healthcare, but Medicare only provides coverage for specific circumstances such as medical emergencies in the United States and certain travel scenarios.
- If a medical professional refuses to file a Medicare claim, a person can file a complaint with Medicare through their State Health Insurance Assistance Program or by contacting Medicare directly.
- For Part C (Medicare Advantage) and Part D (Prescription Drug Plans), the process of filing a claim and dealing with claim cancellations or reversals is slightly different, as claims are handled through the plan, and such actions usually require contacting the plan directly.
