(Medicare Claims Processing Manual)

D. Notice Details   This subsection provides a summary of whom the notice is for and what time period it covers.   POSITION   This subsection has a fixed size and position.  The subsection is printed on a gray highlight box.  The gray area begins (0, 2.75). It is one-column or 259 points in width and 108 points in height.   Indent in 8 points all around to begin content area.  The three lines of body content are organized into static and dynamic text.  Static text is in regular text, without changing content.  Indent 133 points in from left margin to start dynamic text (e.g.,  beneficiarys Medicare number) in bold.       FORMATTING   [GR 1] gray background  [TH 3] notice details header  [GR 4.1] spacing after header  [GR 3.1] dotted rule  [TB 2.1] static body content [TB 2.2] dynamic body content  [GR 3.1] dotted rule  [TB 2.1] stati c body content [TB 2.2] dynamic body content  [GR 3.1] dotted rule  [TB 2.1] static body content [TB 2.2] dynamic body content   DYNAMIC RULES   This subsection is comprised of four lines; each line has both static and dynamic content.   Notice for   The first line has the static text Notice for followed by the beneficiarys given and family names.  Note that for space purposes the middle initial(s) and suffixes should not be included here.   Medicare Number   The second line has a static title and the beneficiarys Medicare number.   When possible, the number should be broken by dashes in the format (e.g., 1EG4- TE5-MK72).  Date of This Notice   The third line has a static title and the date that the notice was printed.  The date is listed with a spelled -out month, numeric day, and complete numeric year (e.g., October 15, 2021).  Claims Processed   On a typical MSN, the fourth line has a static title, Claims Processed Between and dates that represent the start and end dates of the complete claim -processing period.  The first date printed should correspond to the first day of the period that was reviewed for claims prior to the generation of the notice.  The final date printed should reflect the final day that was reviewed for claims prior to the printing of the not ice.  This period typically spans an entire 90 -day period prior to the printing of the notice.  (Note that this is not  the same as the processing dates of the first - and last -processed claims on the notice, which may cover a much shorter period.)   The dates are listed with a spelled -out month, numeric day, and complete numeric year (e.g., October 15, 2021) and are separated by an en- dash (not a hyphen); insert spaces to each side of the en -dash.  If both the first and last date are within the same calendar year, drop the year from the first date (e.g., October 15 -  November 3, 2021) .  If the dates are in different calendar years, keep the year in both dates (e.g., October 15, 2021 -  January 3, 2022).  NOTE:  When printing a Pay MSN or other MSN with a single  processing date, replace static text Claims Processed Between with the label Claims Processed; on an MSN of this kind, only the single processing date should be listed, following the formatting conventions described above.  CONTENT   Notice for {Benefi ciary Given Name}{Beneficiary Family Name}  Medicare Number     {XXXX- XXX- MK72}  Date of This Notice    {Month DD, YYYY}  Claims Processed     {Month DD, YYYY} - Between       {Month DD, YYYY}   Or, if the notice is a Pay MSN or an MSN with a single processing date, use the following:   Notice for {Beneficiary Given Name}{Beneficiary Family Name}  Medicare Number     {XXXX- XXX- MK72}  Date of This Notice    {Month DD, YYYY}  Claims Processed     {Month DD, YYYY}    10.3.4 - Specifications for Header for Other Pages  (Rev.  2522, Issued: 08- 21-12, Effective: 07- 01-12 (Analysis and Design) 10- 01-12 (Final Design Testing) 01 -03-13(Final Implementation), Implementation: 07 -01-12 (Analysis and Design) 10- 01-12 (Final Design Testing) 01- 03-13(Final Implementation)   This element r epeats at the top of every page of the MSN, except for the first page. It contains the beneficiarys name, a notification, and page numbering.   POSITION   This subsection is of a fixed size. It does not vary in overall width or length.  It begins (0, 0) and is full -page or 540 points in width.  The first content unit, the beneficiarys name, is flush left. The second content unit, containing the notification text and page numbering, is flush right.     FORMATTING   [TB 2.2] beneficiary name  [TB 2.2] This Is Not a Bill, all caps, right aligned  [TB 2.1] |, then page number, right aligned   DYNAMIC RULES   This section contains two dynamic elements, the beneficiarys name and the page numbering.   The beneficiarys name should be printed with the given name first, followed by any middle initial(s), the family name, then any suffixes (e.g., Jr.)   The page number indicator, in the format {Page # of #}, must include the number of the page on which the element appears and, in the second numeric position, the  total page count for the notice.   CONTENT   {Beneficiarys Given Name}{Beneficiarys Middle Initials}{Beneficiarys Family Name}{Beneficiarys Suffix}  THIS IS NOT A BILL | {Page # of #}   10.3.5 - Specifications for Section 2: Making the Most of Your Medicare (Page 2)  (Rev. 11509, Issued: 07- 28-22, Effective: 01 -01-23 Implementation: 01- 03-23)  A. Section Title   POSITION   This subsection contains information of a fixed size.  It does not vary in overall width or length.   The content area begins (0, 5), 7 points from the baseline of the Headers for Other Pages subsection.  It is full -page or 540 points in width and 24 points in height.     FORMATTING   [GR 2.1] black rule  [TH 2] section name   DYNAMIC RULES  N/A -  this section is static.   CONTENT  Making the Most of Your Medicare   B. How to Check This Notice   Global Specifications  POSITION   This subsection contains information of varying size per MSN type.  It does not vary in overall width or length per type.   The content area begins (0, 0.94), 28 points from the baseline of the Section Title subsection.  It is one -column or 259 points in width and varies in height depending on the MSN type.  Content is static per type.   Indent 8 points from the top, left, and right, and 12 points at bottom to begin content area.     FORMATTING   [GL 9] glyph [TH 3] subsection header, center vertically to glyph  [GR 4.2] space after glyph  [TB 1.2] first sentence of each paragraph [TB 1.1] remaining text in each paragra ph [GR 6] space between paragraph  [TB 1.2] first sentence of each paragraph [TB 1.1] remaining text in each paragraph  [GR 6] space between paragraph  [TB 1.2] first sentence of each paragraph [TB 1.1] remaining text in each paragraph   DYNAMIC RULES   The body -text content varies depending on which member of the extended family the MSN belongs to -  see the content specifications below.  PART A INPATIENT AND  B OF A,  SPECIFICATIONS   CONTENT   How to Check This Notice  Do you recognize the name of each facility?  Check the dates.  Did you get the claims listed?  Do they match those listed on your receipts and bills?  If you already paid the bill, did you pay the right amount? Check the maximum you may be billed.  See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer.  That plan may pay your share.   HOSPICE AND HOME HEA LTH SPECIFICATIONS   CONTENT   How to Check This Notice  Do you recognize the name of each doctor or provider?  Check the dates.  Did you have a visit or service that day?  Did you get the services listed?  Do they match those listed on your receipts and bills?  If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed.  See if the cla im was sent to your Medicare supplement insurance (Medigap) plan or other insurer.  That plan may pay your share.   PART B (ASSIGNED AND  UNASSIGNED) SPECIFI CATIONS   CONTENT   How to Check This Notice  Do you recognize the name of each doctor or provider?  Che ck the dates.  Did you have an appointment that day?  Did you get the services listed?  Do they match those listed on your receipts and bills?  If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed.  See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer.  That plan may pay your share.   DME (ASSIGNED AND UN ASSIGNED) SPECIFICAT IONS   CONTENT   How to Check this Notice  Do you re cognize the name of each supplier?  Check the dates.  Did you make a purchase that day?  Did you get the items/services listed?  Do they match those listed on your receipts and bills?  If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed.  See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer.  That plan may pay your share.   C. How to Report Fraud   Global Specifications   POSITION   This subsection is fixed in width and varies  in length depending on content, however the position is dynamic.   The content area begins 19 points from the baseline of the How to Check  This Notice subsection.  It is one -column or 259 points in width.    FORMATTING   [GR 2.1] black rule  [GL 10] glyph [TH 3] subsection header, center vertically to glyph  [GR 4.2] space after glyph  [TB 1.1] body text  [GR 6] space between paragraph  [TB 1.1] body text  [GR 6] space between paragraph  [TB 1.2] first sentence highlight [TB 1.1] body text   DYNAMIC RULES   Body -text content in the first paragraph varies depending on which member of the extended family the MSN belongs to -  see the content specifications below.  The third and final paragraph of this section contains a fraud- specific message from CMS.  The messa ge must be a maximum 185 characters long (inclusive of spaces).  The current fraud -specific message can be found on the CMS website: http://www.cms.gov/Medicare/Medicare -General -Information/MSN/index.html?redirect=/MSN/02_MSNMessages.asp   PART A INPATIENT AND  B OF A,   SPECIFICATIONS   CONTENT   How to Report Fraud   If you think a facility or business is involved in fraud, call us at 1- 800-MEDICARE (1 -800-633- 4227).  Some examples of fraud include offers for free medical services or billing you for Medicare services you didnt get.  If we determine that your tip led to uncovering fraud, you may qualify for a reward.  {CMS fraud message of 18 5 characters (four lines of text) The first sentence may be bold, while the remaining text is roman, with occasional bits, such as  monetary figures or important words , highlighted in bold.}  PART B (ASSIGNED AND  UNASSIGNED), HOSPIC E, AND HOME HEALTH SPECIFICATIONS   CONTENT   How to Report Fraud  If you think a provider or business is involved in fraud, call us at 1- 800-MEDICARE (1 -800-633- 4227).   Some examples of fraud include offers for free medical services or billing you for Medicare services you didnt get.  If we determine that your tip led to uncovering fraud, you may qualify for a reward.