Medicare Part B - Durable Medical Equipment - Patient Request for Medical Payment Form

How do I file a claim?
Fill out the claim form, called the Patient Request for Medical Payment form (CMS-1490S) [PDF, 52KB). Follow the instructions for the type of claim you're filing:

• Claims for Part B services -use these instructions [PDF, 205KB].
• Claims for durable medical equipment (DME) - use these instructions [PDF, 162KB].
• Claims for shipboard services (medical services you got aboard a ship) -  use these instructions [PDF, 143KB].
• Claims for services you got in Canada or Mexico - use these instructions [PDF, 148KB].
• Claims for services you got in a foreign hospital - use these instructions [PDF, 149KB].

CLAIMS FOR DURABLE MEDICAL EQUIPMENT (DME) 

Medicare Coverage of Durable Medical Equipment and Other Devices

>>Click HERE for Printable Version or to Read Medicare Coverage of Durable Medical Equipment and Other Devices Publication>>

Free Diabetes Medications - Price Chopper

>>Click HERE to link to PriceChopper.com for Additional Info>>

>>Click HERE for LARGER IMAGE or Printable Version>>

Special Generic Pricing Low Cost Insulin at Walmart Pharmacies

>>Click HERE for LARGER IMAGE or Printable Version>>

National Do Not Call Registry

>>Click here to link to the Federal Trade Commission for additional information>>

Veteran’s Independence Plus program (VIP)

Veteran’s Independence Plus program (VIP) supports veterans of any age that are at risk of nursing home placement and their family caregivers by providing home and community based services to enable them to continue to live in their homes and communities. Eligible veterans receive a comprehensive assessment, develop a service plan, and can purchase goods and services that best meet their needs. VIP is jointly administered by the Executive Office of Elder Affairs and the Department of Veterans’ Services. 

>>Click here to link to HomeCare Partners for more information>>

>>Also see the Program Overview HERE>>

>>Program Overeview in PDF format>>

Pharmacy Outreach Program - Info Request

>>Click HERE for Printable Version>>

Pharmacy Outreach Program FREE service provided by MCPHS University and Massachusetts Executive Office of Elder Affairs

 >>Click HERE for Printable Version>>

Massachusetts College of Pharmacy and Health Science and the Massachusetts Executive Office of Elder Affairs.

The Calm Before the Storm..Disaster Planning, Alzheimer’s Disease and dimentia - Publication by The Hartford

>>Click HERE for Printable Version or to Read Publication>>

Assisted Living Resource Guide and Consumer Guide - Publication by Massachusetts Assisted Living Facilities Association

>>Click HERE for Printable Version or to Read Publication>>