(Medicare Claims Processing Manual)

POSITION OF CONTENT   The front of the envelope contains inform ation of a fixed size. It does not vary in overall width or length.   The Department of Health & Human Services seal, an imported image, is located (0.375, 0.25).  It measures 57 points in width and 57.5 points in height.  The text element starts (1.25, 0.3), indented 6 points from the seal.  It measures 210 points in width and 75 points in height.    POSITION OF ADDRESS WINDOW   For all sizes of the envelope, the window measures 4.5 inches in width and 1.5 inches in height with rounded corners.   On standard #10 and half -size envelopes, the window is located at (0.75, 2.06) from left top corner.  To meet USPS requirements, the window on the standard #10 envelope should be placed 0.625 from the bottom.   [The below figure has been revised.]     On full-size envelopes, the window is located at (0.5, 2) from left top corner.      [The below figure is new.]     See Exhibit 2.14 for layout reference.   FORMATTING   [GL 7] Department of Health & Human Services seal  [TB 1.1] return address  [GR 4.1] space after [TB 2.2] notification line (in all capital letters)   DYNAMIC RULES   n/a  CONTENT   The return mailing address listed should be the preferred mailing address of the MAC generating the MSN.  Complete content is as follows:  [GL 7]   Centers for Medicare & Medicaid Services  c/o { A/B MAC (A), (B), (HHH), or DME MAC  Name}  {MAC  Street Address}  {MAC  City}, {ST} {ZIP+4}  OFFICIAL MEDICARE INFORMATION  B. Front of Pay MSN Envelopes   POSITION OF CONTENT   The front of the envelope contains i nformation of a fixed size.  It does not vary in overall width or length.   The Department of Health & Human Services seal, an imported image, is located (0.375, 0.25). It measures 57 points in width and 57.5 points in height.  The address text element st arts (1.25, 0.3), indented 6 points from the seal.  It measures 210 points in width and 75 points in height.  The return -service text element starts (5, 0.5).  It measures 191 points in width and 26 points in height.  See Exhibit 2.14 for layout reference.   [Figure 10.3.10B has been replaced with figure 10.3.10B1.]     [The below figure is new.]     POSITION OF ADDRESS WINDOW   Reference specifications on Section 10.3.10.A for window position.  FORMATTING   [GL 7] Department of Health & Human Services seal  [TB 1.1] return address  [GR 4.1] space after  [TB 2.2] notification line (in all capital letters)  [TB 2.2] important document line (in all capital letters)   NOTE :  For alternate layout of the important document line, it can be below the notifi cation line.   DYNAMIC RULES   n/a  CONTENT   The return mailing address listed should be the preferred mailing address of the MAC generating the MSN.  Complete content is as follows:  [GL 7]   Centers for Medicare & Medicaid Services  c/o { A/B MAC (A), (B), (HHH), or DME MAC  Name}  {MAC  Street Address}  {MAC  City}, {ST} {ZIP+4}  OFFICIAL MEDICARE INFORMATION IMPORTANT DOCUMENT ENCLOSED   C. Back of All Envelopes   POSITION   The back of the envelope contains information of a fixed size.  It does not vary in overa ll width or length.   On standard #10 envelopes, the content area begins 0.375 inches from the top margin and is centered to the width of the envelope.  It is 459 points in width and 48 points in height.  The vertical position may be adjusted slightly depending on the shape and height of the envelope flap.   On half - and full -size envelopes, the content area begins 0.5 inches from the top margin and is centered to the width of the envelope.  It is 433 points in width and 48 points in height.  The vertical pos ition may be adjusted slightly depending on the shape and height of the envelope flap.   See Exhibit 2.14 for layout reference.     FORMATTING   [TB 2.1] instructions, center aligned  [GR 4.1] space after  [TB 2.2] notification line, all caps, center aligned   DYNAMIC RULES   n/a  CONTENT   For help regarding your notice, call us at 1- 800-MEDICARE (1 -800-633-4227).   If you change your address, contact the Social Security Administration at 1 -800-772-1213.  TO BE OPENED BY ADDRESSEE ONLY   D. Envelope Liner  All Pay envelopes must have a security liner inside the envelope to ensure the inserted check cannot be seen through.  Shown below is a suggested pattern using the DHHS seal.  The artwork will be provided as GL 8 in vector and flash image formats.  The MACs may also use a standard pattern if the recommended custom pattern will be costly to implement.     E. Coversheet   All MACs are encouraged to print on customized envelopes without coversheets.  However, if there is a need to have coversheets, the address block should follow the same specifications to those on the MSN.  See 10.3.3.C Recipient Address subsection for specifications.   10.3.11 - Specifications for RRB Specialty MAC MSNs  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)  RRB  Specialty MAC (S MAC) MSNs produced by Palmetto GBA will follow the design Specifications for the Medicare MSNs.  Since RRB is an independent Federal agency, the DHHS seal and Medicare contact numbers/website will be replaced by appropriate content for RR B.  Exceptions are noted below.   See Exhibit 1.9 for an example of RRB S MAC MSN in English and Exhibit 3.9 for RRB S MAC MSN in Spanish.   The envelope design and watermark on paper from previous RRB Part BS MAC MSN design will be used as is.  A. Notice Ti tle (10.3.3.A)   Replace RRB logo and descriptive tagline.   [The below figure is new.]     FORMATTING  [GL 9] RRB logo  [TH 1.1] notice title  [TH 1.2] notice subtitle, indicating to which Medicare program the notice relates  [GR 8] space after Notice title  [TB 3] notice descriptive tagline   CONTENT  Notices with only claims paid by the RRB S MAC program should have text content as follows:   Medicare Summary Notice  for Part B (Medical Insurance)  The Official Summary of Your Medicare Claims from the RRB Specialty Medicare Administrative Contractor   B. Foreign Language Footer (10.3.3.J)  Replace 1 -800-MEDICARE with RRBs contact number.  [The below figure is new.]     FORMATTING  [GL 2 -RRB] foreign -language footer   C. How to Report Fraud (10.3.4.C)   Replace 1 -800-MEDI CARE with RRBs contact number.  [The below figure is new.]    CONTENT   How to Report Fraud  If you think a provider or business is involved in fraud, call us at 1- 800-833-4455. 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 185 characters (four lines of text)  The first sentence may be bold, while the remaining text is regular, with occasional bits, such as  monetary figures or important words , highlighted in bold.}   D. How to Get Help with Your Questions (10.3.4.D)   Replace 1 -800-MEDICARE with RRBs contact number.  [The below figure is new.]     CONTENT   How to Get Help with Your Questions  1-800-833-4455   Your customer -service code is {5- DIGIT S MAC ID CODE}.  Representatives are available 8:30 a.m. until 7 p.m. Eastern Time, Monday through Friday.   TTY 1 -877-566-3572 (for hearing impaired)   Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling.  Call {10- DIGIT PHONE NUMBER FOR SHIP IN RECIPIENTS STATE OF RESIDENCE}.   Or, if the MSN mailing address is outside the 50 U.S. states and U.S. territories:  How to Get Help with Your Questions  1-800-833-4455   Your customer -service code is {5- DIGIT S MAC ID CODE}.  Representatives are available 8:30 a.m. until 7 p.m. Eastern Time, Monday through Friday.  TTY 1 -877-566-3572 (for hearing impaired)   E. Get More Details (10.3.8.B)   Replace 1 -800-MEDICA RE with RRBs contact number. [The below figure is new.]     CONTENT   Get More Details  If a claim was denied, call or write the provider and ask for an itemized statement for any claim.  Make sure they sent in the right information.  If they didnt, ask the provider to contact our claims office to correct the error.  You can ask the provider for an itemized statement for any service or claim.   Call 1 -800-833-4455 for more information about a coverage or payment decision on this notice, including laws or pol icies used to make the decision.   F. If You Need Help Filing Your Appeal (10.3.8.D)   Replace 1 -800-MEDICARE with RRBs contact number.  [The below figure is new.]     CONTENT   If You Need Help Filing Your Appeal  Contact us: Call 1 -800-833-4455 or your State Health Insurance Program (see page 2) for help before you file your written appeal, including help appointing a representative.   Call your provider: Ask your provider for any information that may help you.  Ask a friend to help: You can appoint someone, such as a family member or friend, to be your representative in the appeals process.   Or, if the MSN mailing address is outside the 50 U.S. states and U.S. territories, use the following language:   If You Need Help Filing Your Appeal  Contact us: Call 1- 800-833-4455 for help before you file your written appeal, including help appointing a representative.   Call your provider: Ask your provider for any information that may help you.  Ask a friend to help: You can appoint someone, such as a family member or friend, to be your representative in the appeals process.   G. Find Out More (10.3.8.E)   Replace Medicares website with Palmettos website.   [The below figure is new.]     CONTENT   Find Out More About Appeals  For more information about appeals, read your Medicare & You handbook or visit us online at http://www.palmettogba.com/rr/me .  10.3.12 - Specifications for SSA Part B MSNs (Rev. 3210, Issued: 03- 03-15, Eff ective: 04 -16-15. Implementation: 04- 16-15)  SSA Part B MSNs produced by Palmetto GBA will follow the design specifications for the Medicare MSNs, including use of DHHS logo and contact numbers.   See Exhibit 1.5 and Exhibit 1.6 for examples of Part B Assig ned and Unassigned MSNs.   10.3.13 - Character Measurements for Fonts  (Rev. 3210, Issued: 03- 03-15, Effective: 04- 16-15. Implementation: 04- 16-15)