(Claims Processing)

Medicare Claims Processing Manual Chapter 21 - Medicare Summary Notices  New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs                               Other Description21 10 A-00-95,B-00-72, A-97-8, AB-98-31, B-98-4, A-99-48, AB-01-23  General MSN Requirements 21 10.1 A3-3726 A-99-48,A-01-54  General Requirements for the Medicare Summary Notice (MSN) 21 10.2     Correction/Reissuance of Faulty MSNs 21 10.3 A-99-48 Carrier and Intermediary Instructions for Preparing Medicare Summary Notice 21 10.3.1 A3-3726.1  AB-98-31  General Requirements - MSN 21 10.3.2 A3-3726.2 BB3-7003   Basic Concepts and Approaches 21 10.3.3 A3-3726.3 B3-7004   Format for the MSN 21 10.3.4 A3-3726.4 B3-7006   Technical Specifications for the Medicare Summary Notice (MSN) 21 10.3.5 A3-3726.5 B3-7006.1 AB-98-31,AB-02-106  Title Section of the MSN 21 10.3.6 A3-3726.6 B3-7006.2 A-00-36  Claims Information Section 21 10.3.7 A3-3726.7 B3-7006.3 Message SectionNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21                                                                    10.3.8 A3-3726.8 B3-7006.4 AB-02-106  Appeals Section21 10.3.9 A3-3726.9 B3-7006.5 Continuation Page21 10.3.10  MSN Calculations21 10.3.10.1  A3-3726.10 Intermediary Calculations21 10.3.10.2 B3-7007.1 Carrier Calculations21 10.3.11 A3-3726.11,A3-3726.11  B3-7008, B3-7008 A-00-58, A-01-93  Back of the MSN - Carriers and Intermediaries 21 10.3.12 A3-3726.12 B3-7010   Separation of Claim Line Items on MSN 21 10.3.13 A3-3726.13 B3-7011   Suppression of Claims from MSNs 21 20     Specifications for Spanish MSN 21 20.1  B3-7006.6 AB-02-106  Spanish MSN  21 20.2 Disclaimer Section21 20.3 B3-7006.7 Title Section21 20.4  B3-7006.8   Claims Information Section 21 20.5 B3-7006.9 Message Section21 20.6 B3-7006.10  AB-02-106  Appeals Section21 20.7  B3-7006.11 A-99-48  Text and Specifications for Spanish MSN Back 21 20.7.1     Carrier Spanish MSN Back 21 20.8 A-99-48,A-01-93  Intermediary Spanish MSN Back 21 30 ExhibitsNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21 30.1                                                                                       A3-3726.13 Intermediary Exhibits21 30.2 B3-7012 Carrier Exhibits21 40 A3-3726.14 B3-7013   Explanatory and Denial Messages 21 50 A3-3726.14A B3-7014 AB-02-106  Categories and Id entification Numbers for Approved MSN Messages  21 50 B-02-047,AB-02-155,AB-02-151  Categories and Identification Numbers for Approved MSN Messages  21 50.1 Ambulance21 50.2 Blood21 50.3 Chiropractic21 50.4 ESRD21 50.5 Name/Number/Enrollment21 50.6 Drugs21 50.7 B-02-047 Duplicates21 50.8 B-01-13,B-02-029  Durable Medical Equipment 21 50.9     Failure to Furnish Information 21 50.10 Foot Care21 50.11  A3-3110   Transfer of Claims 21 50.12 Hearing Aids21 50.13 B-00-67,AB01159 Skilled Nursing Facility New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description AB-01-159 21 50.14                                                                                 Laboratory21 50.15 AB-01-79,AB-02-155,A-03-068 Medical Necessity21 50.16 B-01-10,B-01-21, AB-01-79, A-01-69, A-01-132 Miscellaneous21 50.17 AB-03-057 Non-Physician Services21 50.18 AB-02-010 Preventive Care21 50.19 Hospital Based Physicians21 50.20 AB-02-151 Benefit Limits21 50.21 Restriction to Coverage21 50.22 Split Claims21 50.23 Surgery21 50.24 AB-02-106 Fraud And Abuse Section (Help Stop Fraud) 21 50.25     Time Limit For Filing 21 50.26 Vision21 50.27 HospiceNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21 50.28     Mandatory Assignment for Ph ysician Services Furnished for Medicaid Patients 21 50.29                                                                           MSP21 50.30     Reasonable Charge And Fee Schedule 21 50.31 Adjustments21 50.32 Overpayments/Offsets21 50.33 Ambulatory Surgical Care21 50.34   B-01-21  Patient Paid / Split Payment 21 50.35     Supplemental Coverage / Medigap 21 50.36 Limitation of Liability21 50.37 Deductible/Coinsurance21 50.38 AB-02-106 General Information Section21 50.41 Home Health Messages21 50.42 AB-00-30 Religious Nonm edical Health Care Institutions 21 60 Add-On Messages21 70 Mandated Messages21 80 B-00-48,AB-01-30, AB-01-97, AB-01-14 Demonstration ProjectNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21                                                                            90 A3-3110 A-99-48,B-02-047 Spanish Messages21 90.1 Ambulancia21 90.2 Sangre21 90.3 Quiroprctico21 90.4 Deficiencia Renal Terminal21 90.5 Nmero/Nombre/Inscripcin21 90.6 Drogas21 90.7 B-02-047 Duplicados21 90.8 B-01-13,B-02-029  Equipo Mdico Duradero  21 90.9     Falta De Informacin Sometida  21 90.10     Cuidado De Los Pies  21 90.11  A3-3110   Reclamaciones Transferidas  21 90.12 Audifonos21 90.13 B-00-67,AB-01-159  Instalacion De Enfermeria Especializada 21 90.14 Laboratorios21 90.15 AB-01-79,AB-02-155,A-03-068  Necesidad Medica  New Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21                                                                           90.16 B-01-10.AB-01-79, B-01-21, A-01-69, A-01-132 Miscelaneo21 90.17   AB-03-057  Servicios Que No Fueron Prestados Por Doctores  21 90.18 AB-02-010 Cuidado Preventivo21 90.19     Servicios Medicos Prestados En Un Hospital  21 90.20   AB-02-151  Limites En Los Beneficios  21 90.21     Restricciones A La Cobertura  21 90.22 Reclamaciones Separadas21 90.23 Cirugia21 90.24 AB-02-106 Mensajes Para Ayudar A Detener El Fraude  21 90.25     Tiempo Limite De Enviar La Reclamacion  21 90.26 Vision21 90.27 Hospicio21 90.28 Asignacion Mandatoria21 90.29 MSP21 90.30 Cargos Razonables21 90.31 Ajustes21 90.32 SobrepagosNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21 90.33     Cuidado Quirurgico Ambulatorio  21 90.34   B-01-21  Patient Paid / Split Payment 21 90.35     Cubierta Suplementaria/ Medigap  21 90.36     Reclamaciones Cuando Se Acepta Asignacin  21 90.37                                                           Deducible/Coaseguro21 90.38   AB-02-106  Seccion De Informacin General 21 90.39     Section 39-Spanish ADD-ON Messages 21 90.40     Section 40-Spanish Mandated Messages 21 90.41     HHA - Agencia De Servicios De Salud En El Hogar 21 90.42 AB-00-30 Servicios De Cuidado De Salud No Medico Religioso 21 90.43 AB-01-30 Projecto Especial (Demostraciones)21 90.43 AB-01-30,AB-01-97, AB-01-149  Projecto Especial (Demostraciones) 21 100   AB-98-59  Detailed Map From MSN to ANSI X12 Remittance Message Codes 21 100.1 Ambulance21 100.2 Blood21 100.3 Chiropractic21 100.4 ESRD21 100.5 Name/Number Enrollment21 100.6 DrugsNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21 100.7                                                                                             Duplicates21 100.8 B-01-13,B-02-029  Durable Medical Equipment 21 100.9     Failure to Furnish Information 21 100.10 Foot Care21 100.11 Transfer of Claims21 100.12 Hearing Aids21 100.13 B-00-67,AB-01-159  Skilled Nursing Facility 21 100.14 Laboratory21 100.15 Medical Necessity21 100.16 B-01-10,A-01-132, A-01-69, AB-01-79, B-01-21 Miscellaneous21 100.17 Non-Physician Services21 100.18 Preventive Care21 100.19 Hospital Based Physicians21 100.20 Benefit Limits21 100.21 Restriction to Coverage21 100.22 Split ClaimsNew Chap. New Sect. Int.  Pub. 13 Carrier Pub. 14 PMs Other Description 21 100.23