CMS-1490S attachment checklist (itemized bills, EOBs, and signature rules)

• Completed CMS-1490S with required sections filled.
• Itemized bill(s) from each provider or supplier.
• Other-insurance documentation when Medicare is secondary.
• Signature and date from the patient, or witness details if the patient cannot sign.
• Recipient address verified against current Medicare contractor guidance.

The form instructions call for itemized billing details such as:

• Date of service.
• Place of service.
• Description of illness or injury.
• Description of each surgical medical service or supply furnished.
• Charge for each service.
• Doctor or supplier name and address.
• Provider or supplier NPI, if known.

Missing details here are a common reason claims are delayed.

If Medicare is secondary and another insurer handled the claim first, include the primary insurer's Explanation of Benefits when available.

This helps Medicare coordinate benefits and review payment context faster.

For most submissions:

• Patient signs and dates the form.

If the patient cannot sign:

• The signer can sign on the patient's behalf.
• Complete the witness section fully, including witness name, address, relationship, signature, date, and brief explanation.

Use a consistent order:

1. Cover letter (optional but useful).
2. Completed CMS-1490S.
3. Itemized bill(s) and supporting records.
4. Primary insurer EOB and related insurance documents.

Keep pages legible and aligned to standard page size.

• Uploading only CMS-1490S without bills.
• Including blurry scans or cut-off documents.
• Inconsistent names or claim identifiers across documents.
• Missing witness details when signing on behalf of the patient.
• Mailing without confirming the correct Medicare contractor address.

• CMS-1490S official form PDF
• Medicare: How do I file a claim?