evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
DYNAMIC RULES   The content in this section is nearly entirely dynamically generated. It includes the following content elements:   Date(s) of Service   The date of service is listed with a spelled -out month, numeric day, and complete numeric year (e.g., October 15, 2021).   If a single claim includes multiple dates of service, list the first and last date of service for the claim, separated by an en -dash; insert spaces to either side of the en -dash.  If both the first and last dates 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).  Supplier Name   Print the complete name of the supplier that filed the c laim for services.  If the supplier is a physician, when printing a degree suffix (e.g., M.D.) with the name, place a period after the M and after the D.  The name and any suffix should be separated by a comma.   Supplier Phone Number   Print the supplie r 10-digit phone number, preceded by a comma to separate it from the supplier name.  Enclose the area code within parentheses.  Insert a dash between the third and fourth digit of the local phone number.   If available, print the phone number associated wit h the billing department of the supplier that filed the claim for services.  If a specific billing contact number is not available, print the primary phone number for the supplier.  If no phone number for the supplier is available, suppress this content el ement and its preceding comma.   Supplier Address   Print the suppliers street address, city, state abbreviation, and ZIP code +4. Insert a comma between the practice name, street address and city, and between the city and state abbreviation.   If available,  print the physical address of the supplier.  If the physical address is not available, print the mailing or billing address for the supplier.  If no address for the supplier is available, suppress this content element.   Ordering Provider
(Medicare Claims Processing Manual)
If available,  print the physical address of the supplier.  If the physical address is not available, print the mailing or billing address for the supplier.  If no address for the supplier is available, suppress this content element.   Ordering Provider   If the beneficia rys supplies were ordered by a provider, print the ordering providers full name here, preceded by the phrase Ordered by.  When printing a degree suffix (e.g., M.D.) with a name, place a period after the M and after the D.  Ordering physician name and any suffix should be separated by a comma.  If the NPI submitted on the claim is not on file, use the name as shown on the claim.  Suppress the Ordered by line if not able to identify the doctor.  For A/B MACs (B), if the ordering physician is the sam e as any performing physician on the claim, suppress the ordering physician line.  If the NPI submitted on the claim is not on the A/B MAC (B)s file, suppress the Ordered by line.   CONTENT   {Date(s) of Service}   {Supplier Name}, {10 -digit phone number f or supplier}   {Supplier Street Address}{Supplier State}{Supplier ZIP+4}   Ordered by {Provider Title} {Provider Given Name}{Provider Middle Initial}{Provider Family Name}   D. Claim Column Titles   The language used for the column headers differs for each mem ber of the extended family of MSNs.  See the specific content specifications below for details.     PART A INPATIENT SPECIFICATIONS   POSITION/FORMATTING   This subsection is directly after the claims  header subsection.  It is full -page or 540 points in width and 42.25 points in height.  Content should have 5 points of space from top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligne d.  See figure 10.3.6.D1 and Exhibit 1.1 for reference.   Listed below are widths and formatting for each column:
(Medicare Claims Processing Manual)
Listed below are widths and formatting for each column:   Column 1:  188 points wide, no content  Column 2:  42 points wide, [TH 5.1] right aligned  Column 3:  62 points wide, [TH 5.1] right aligned  Column  4: 66 points wide, [TH 5.1] right aligned  Column 5:  71 points wide, [TH 5.1] right aligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the column Column  7: 38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   n/a - the content in this subsection is static.   CONTENT   (blank)  Benefit Days Used  Claim Approved?  Non-Covered Charges  Amount Medicare Paid  Maximum You May Be Billed  See Notes B elow   HOSPICE AND HOME HEA LTH SPECIFICATIONS   POSITION/FORMATTING  This subsection is directly after the claims  header subsection.  It is full -page or 540 points in width and 42.25 points in height.  Content should have 5 points of space from the top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligned.  See figure 10.3.6.D2, Exhibit 1.3, and Exhibit 1.4 for reference.   Listed below are widths and formatting for each column:   Column 1:  174 points wide, [TH 5.1] left aligned  Column 2:  52 points wide, [TH 5.1] right aligned  Column 3:  66 points wide, [TH 5.1] right aligned  Column 4:  66 points wide, [TH 5.1] right aligned  Column 5:  71 points wide, [TH 5.1] right aligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the column Column 7:  38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   The content in this subsection is static.   CONTENT   Quantity & Service Provided Service Approved?  Amount Provider Charged Medicare- Approved Amount  Amount Medicare Paid  Maximum You May Be Billed  See Notes Below   PART B ASSIGNED SPEC IFICATIONS
(Medicare Claims Processing Manual)
DYNAMIC RULES   The content in this subsection is static.   CONTENT   Quantity & Service Provided Service Approved?  Amount Provider Charged Medicare- Approved Amount  Amount Medicare Paid  Maximum You May Be Billed  See Notes Below   PART B ASSIGNED SPEC IFICATIONS   POSITION/FORMATTING  This subsection is directly after the claims  header subsection.  It is full -page or 540 points in width and 42.25 points in height.  Content should have 5 points of space from the top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligned.  See figure 10.3.6.D2, Exhibit 1.5 for reference.   Listed below are widths and formatting for each column:   Column 1:  174 points wide, [TH 5.1] left aligned  Column 2:  52 points wide, [TH 5.1] right aligned  Column 3:  66 points wide, [TH 5.1] right al igned  Column 4:  66 points wide, [TH 5.1] right aligned  Column 5:  71 points wide, [TH 5.1] right aligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the c olumn Column 7:  38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   The content in this subsection is static.   CONTENT   Service Provided & Billing Code  Service Approved?  Amount Provider Charged Medicare- Approved Amount  Amount Medicare Paid  Maximum You May Be Billed  See Notes Below   PART B UNASSIGNED SPECIFICATIONS   POSITION/FORMATTING  This subsection is directly after the claims header subsection.  It is full- page or 540 points in width and 42.25 points in height.  Content should have 5 points of space from the top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligned.  See figure 10.3.6.D2 and Exhibit 1.6 for reference.   Listed below are widths and formatting for each column:
(Medicare Claims Processing Manual)
Listed below are widths and formatting for each column:   Column 1:  174 points wide, [TH 5.1] left aligned  Column 2:  52 points wide, [TH 5.1] right aligned  Column 3:  66 points wide, [TH 5.1] right aligned  Column 4:  66 points wide, [TH 5.1] right aligned  Column 5:  71 points wide, [TH 5.1] right a ligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the column Column 7:  38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   n/a - the content in this subsection is static.   CONTENT   Service Provided & Billing Code  Service Approved?  Amount Provider Charged Medicare- Approved Amount  Medicare Paid You  Maximum You May Be Billed  See Notes Below   B OF A  SPECIFICATIONS   POSITION/FORMATTING  This subsection is directly after the claims header subsection.  It is full- page or 540 points in width and 42.25 points in height.  Content should have 5 points of space from the top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligned.  See figure 10.3.6.D2 and Exhibit 1.2 for reference.   Listed below are widths and formatting for each column:   Column 1:  174 points wide, [TH 5.1] left aligned  Column 2:  52 points wide, [TH 5.1] right al igned  Column 3:  66 points wide, [TH 5.1] right aligned  Column 4:  66 points wide, [TH 5.1] right aligned  Column 5:  71 points wide, [TH 5.1] right aligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the column Column 7:  38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   n/a - the content in this subsection is static.   CONTENT   Service Provided & Billing Code  Service Approved?  Amount Facility Charged  Medicare- Approved Amount  Amount Medicare Paid  Maximum You May Be Billed  See Notes Below   DME ASSIGNED SPECIFI CATIONS
(Medicare Claims Processing Manual)
DYNAMIC RULES   n/a - the content in this subsection is static.   CONTENT   Service Provided & Billing Code  Service Approved?  Amount Facility Charged  Medicare- Approved Amount  Amount Medicare Paid  Maximum You May Be Billed  See Notes Below   DME ASSIGNED SPECIFI CATIONS   POSITION/FORMATTING   This subsection is directly after the claims header subsection.  It is full- page or 540 points in width and 42.25 points in height.  Content should have 5 points of space from the top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligned.  See figure 10.3.6.D2 and Exhibit 1.7 for refere nce.  Listed below are widths and formatting for each column:   Column 1:  174 points wide, [TH 5.1] left aligned  Column 2:  52 points wide, [TH 5.1] right aligned  Column 3:  66 points wide, [TH 5.1] right aligned  Column 4:  66 points wide, [TH 5.1] right align ed Column 5:  71 points wide, [TH 5.1] right aligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the column Column 7:  38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   n/a - the content in this subsection is static.   CONTENT   Quantity, Item/Service Provided & Billing Code  Item/Service Approved?  Amount Supplier Charged Medicare- Approved Amount  Amount Medicare Paid  Maximum You May Be Billed  See Notes Below   DME UNASSIGNED SPECI FICATIONS   POSITION/FORMATTING  This subsection is directly after the claims header subsection.  It is full- page or 540 points in width and 42.25 points in height.  Content  should have 5 points of space from the top and 7 points of space from the bottom.  There are seven columns with varying widths.  All content is to be bottom aligned.  See figure 10.3.6.D2 and Exhibit 1.8 for reference.   Listed below are widths and formatt ing for each column:
(Medicare Claims Processing Manual)
Listed below are widths and formatt ing for each column:   Column 1:  174 points wide, [TH 5.1] left aligned  Column 2:  52 points wide, [TH 5.1] right aligned  Column 3:  66 points wide, [TH 5.1] right aligned  Column 4:  66 points wide, [TH 5.1] right aligned  Column 5:  71 points wide, [TH 5.1] rig ht aligned with 5 point indent  Column 6:  73 points wide, [TH 5.2] right aligned with 3.5 point intent, white text on black fill and [GR 2.2] on both sides of the column Column 7:  38 points wide, [TH 5.1] left aligned with 5 point indent   DYNAMIC RULES   n/a - the content in this subsection is static.   CONTENT   Quantity, Item/Service Provided & Billing Code  Item/Service Approved?  Amount Provider Charged Medicare- Approved Amount  Medicare Paid You  Maximum You May Be Billed  See Notes Below   E. Claim Content Line s  The content in the claim lines is beneficiary -specific and also differs for each member of the extended family of MSNs.  See the specific content specifications below for details.   POSITION   This subsection is directly after the claim column titles subsection.  It is full -page or 540 points in width and has a variable height, depending on the number of service line items in the given claims.  There are seven columns, corresponding to the column titles subsection.  All content is top aligned.   PART A INPATIENT SPECIFICAT IONS     FORMATTING   [GR 3.2] dotted rule [GR 2.2] black rule  Column 1:  [TB 2.1] benefit period, left aligned  Column 2:  [TB 2.1] approved status, right aligned Column 3:  [TB 2.1] amount charged, right aligned Column 4:  [TB 2.1] amount approved t, right aligned Column 5:  [TB 2.1] amount paid, right aligned, with 5 point indent  Column 6:  [TB 2.2] maximum, right aligned, with 3.5 point indent  Column 7:  [TB 2.2] note indicator, left aligned, with 5 point indent
(Medicare Claims Processing Manual)
NOTE:  When there is more than one service line, start with [GR 3.2] dotted rule to allow distinction between the services by the dotted rule.  The first line of column 6 will have [GR 2.2] on top and sides of the column.  Subsequent lines will have [GR 2.2] on the si des only.   DYNAMIC RULES   The content in this section is nearly entirely dynamically generated.  It includes the following content elements:   Description of Part A Inpatient Service   This column should contain the associated benefit -period start date.  La nguage options include:   Benefit period starting {Month DD, YYYY}   The date of service is listed with a spelled -out month, numeric day, and complete numeric year (e.g., October 15, 2021).   If there is no active benefit period because the claims are rejected, leave this field blank.  Benefit Days Used   This column shows the number of benefit days used during the hospital or skilled nursing facility admission , it indicates that a claim did not use benefit days because all the beneficiarys benefit days for th e given period have been exhausted, or there was no active benefit period because the claim was rejected .  Language options include:   1 day  {#} days  none remain  none   See Exhibit 2.7 for an example of the none remain option.  Claim Approved?   This column indicates if a claim item was approved or denied. It also indicates if a claim was adjusted.  Language options include:   Yes NO Yes -  adjusted  NO -  adjusted   See Exhibit 2.8 for an example of an adjusted claim (this example shows a Part B MSN, but it can be understood to also apply to other members of the extended family).   Non-Covered Charges   This column lists the amount of any claim charges that Medicare did not cover.  Non -covered services will include beneficiary -liable as well as provider -liable charges.  This figure may be up to eight digits long, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the hundreds digit of any four -figure or higher amount.  Use $0.00 for zero.   Amount Medicare Paid  This column lists the amount that Medicare paid toward the claim.  This figure may be up to eight digits long, including cents:   ${###,###.##}
(Medicare Claims Processing Manual)
Amount Medicare Paid  This column lists the amount that Medicare paid toward the claim.  This figure may be up to eight digits long, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the hundreds digit of any four -figure or higher amount.  Use $0.00 for zero.   Maximum You May Be Billed   This column lists the beneficiarys total liability for the claim item.  This figure may be up to eight digits long, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the hundreds digit of any f our-figure or higher amount.  Use $0.00 for zero.   See Notes Below   This column displays indicators that refer to explanations listed in the Notes for Claims Above subsection, which is printed at the bottom of the page when applicable.  Note indicators use  capital letters, and indicators should be printed in alphabetic order, with a comma without space preceding each indicator after the first indicator for a line (e.g., A,B,C). Show no more than three alphabetic indicators per line.  If more than three indicators are required, print on the next line below.  A maximum of five notes are allowed per service, so no more than five note indicators should ever be listed here.   If the same message is needed for more than one claim or service line on a single page, print the same alphabetic code each time the message is required on that page.  If, however, that same message is required on a following page, use a new indicator letter in the appropriate alphabetical order for that page.   Continue alphabetical order from  page to page - do not restart the alphabet on each new page.   If more than 26 alphabetic codes are needed, begin using lowercase alphabetic codes (e.g., a,b,c). If more than 52 alphabetic codes are needed, repeat using capital letters.   CONTENT   {Inpatient hospital benefit period starting Month DD, YYYY} [or] {Skilled nursing facility benefit period starting Month DD, YYYY}
(Medicare Claims Processing Manual)
CONTENT   {Inpatient hospital benefit period starting Month DD, YYYY} [or] {Skilled nursing facility benefit period starting Month DD, YYYY}   1 day [or] {#} days [or] none remain  Yes [or] NO [or] Yes -  adjusted [or]  NO - adjusted  ${###,###.##} ${###,###.##} ${###,###.##}  {NOTE INDICATOR(S)}   or  [blank]  none  Yes [or]  NO [or] Yes -  adjusted [or]  NO -  adjusted  ${###,###.##} ${###,###.##} ${###,###.##}  {NOTE INDICATOR(S)}   HOSPICE SPECIFICATIO NS  See Exhibit 1.3 for layout reference.     FORMATTING   [GR 3.2] dotted line [GR 2.2] black rule   Column 1:  [TB 2.2] quantity and level of care description, left aligned  or [TB 2.] quantity and service visit description, left aligned  Column 2:  [TB 2.1] approved status for level of care, right aligned  Column 3:  [TB 2.1] amount charged for level of care, right aligned  Column 4:  [TB 2.1] amount approved for level of care, right aligned  Column 5:  [TB 2.1] amount paid for level of care, right aligned, with 5 point indent  Column 6:  [TB 2.2] maximum for level of care, right aligned, with 3.5 point indent  Column 7:  [TB 2.2] note indicator for level of care, left aligned, with 5 point indent   NOTE:  Columns 2 through 7 should be filled only for level of care.  They should be left blank for service visit lines.  The first line of column 6 will have [GR 2.2] on top and sides of the column. Subsequent lines will have [GR 2.2] on the sides only.   NOTE:  Between level of care and service visit lines, insert [GR 5] 7 point space in between the claim lines.  There is no dotted lin e in between.   DYNAMIC RULES   The content in this section is entirely dynamically generated.  It includes the following content elements:   Quantity & Service Provided
(Medicare Claims Processing Manual)
DYNAMIC RULES   The content in this section is entirely dynamically generated.  It includes the following content elements:   Quantity & Service Provided   This column should contain the quantity or number of level of care provided, followed by  the description of the level of care provided in bold.  Then items below should contain the quantity or number of service visit provided, followed by the description of the service visit provided. There may be multiple service visit types per one level of  care.   Whenever possible, the number of level of care and service visit provided should be expressed as a whole number, without decimal point or trailing zero (e.g. 2, not  2.0).  Only if the number is a partial quantity, then include a decimal point and a  fractional amount, rounded to the nearest tenth (e.g. 2.5, not 2.49).  Use the most -recent level of care and service visit descriptions. Suppress the billing code.   Service Approved?   This column indicates if a claim item was approved or denied. It also i ndicates if a claim was adjusted. Language options include:   Yes NO Yes -  adjusted   NO -  adjusted   See Exhibit 2.8 for an example of an adjusted claim.  Amount Provider Charged   This column lists the amount of the charge the provider submitted.  This figure field has a maximum of 11 characters, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the hundreds digit of any four -figure or higher amount.  Use $0.00 for zero.   Medicare -Approved Amount   This column lists the amo unt that Medicare allows for the service.  This field has a maximum of 11 characters, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the hundreds digit of any four -figure or higher amount.  Use $0.00 for zero.   Amount Med icare Paid   This column lists the amount that Medicare paid toward the claim.  This field has a maximum of 11 characters, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the hundreds digit of any four -figure or higher amount.  Use $0.00 for zero.   Maximum You May Be Billed  This column lists the beneficiarys total liability for the claim item.  This field has a maximum of 11 characters, including cents:
(Medicare Claims Processing Manual)
Maximum You May Be Billed  This column lists the beneficiarys total liability for the claim item.  This field has a maximum of 11 characters, including cents:   ${###,###.##}  Insert a comma between the thousands digit and the  hundreds digit of any four -figure or higher amount.  Use $0.00 for zero.   See Notes Below   This column displays indicators that refer to explanations listed in the Notes for Claims Above subsection, which is printed at the bottom of the page when appli cable.   Note indicators use capital letters, and indicators should be printed in alphabetic order, with a comma without space preceding each indicator after the first indicator for a line (e.g., A,B,C). Show no more than three alphabetic indicators per line.  If more than three indicators are required, print on the next line below.  A maximum of six notes are allowed per service, so no more than six note indicators should ever be listed here.   If the same message is needed for more than one claim or service line on a single page, print the same alphabetic code each time the message is required on that page.  If, however, that same message is required on a following page, use a new indicator letter in the appropriate alphabetical order for that page.   Continue alphabetical order from page to page - do not restart the alphabet on each new page.   If more than 26 alphabetic codes are needed, begin using lowercase alphabetic codes (e.g., a,b,c). If more than 52 alphabetic codes are needed, repeat using capital le tters.   CONTENT   {Level of care description} {Service visit description}  Yes [or]  NO [or] Yes -  adjusted [or]  NO -  adjusted  ${###,###.##} ${###,###.##} ${###,###.##} ${###,###.##}  {NOTE INDICATOR(S)}   HOME HEALTH SPECIFIC ATIONS   See Exhibit 1.4 for layout reference.     FORMATTING