Health Insurance Reimbursement for your testing may be possible, and included in your result packet are several forms that may be useful. Please contact your Health Insurance provider for specific instructions on submitting for your claim for reimbursement.
Medicare Reimbursement Instructions
The following instructions are meant to be suggestions only and do not guarantee a successful reimbursement, and the Bedford Research Foundation is not liable for any rejections that occur when attempting to submit for a health insurance reimbursement.
To submit to Medicare, please fill out the following form posted at:
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS1490S-ENGLISH.pdf
Under “Reason for submitting this claim”, select “The provider or supplier is unable to file a claim for the Medicare Covered Services”
Under “Type of Patient’s Request”, select “Influenza/Pneumococcal Vaccination, Part B (includes physician, laboratory, imaging services), Foreign Travel (including Canada and Mexico) and/or Shipboard Services”
Fill out CMS-1500 form
Fill in the included CMS-1500 form with all of your information, and follow the directions below in the “PHYSICIAN OR SUPPLIER INFORMATION” section.
1 – Fill in date of testing
2 – Fill in OPT/HCPCS as: 87635
3 – Rendering Provider ID#: 1013154749
Submit both forms to:
National Government Services, Inc.
P.O. Box 6178
Indianapolis, IN 46206-6178
For medicare.
For Example:
