evekhm/cms_iom_500 huggingface dataset:
(Medicare Claims Processing Manual)
DYNAMIC RULES   This subsection can accommodate up to four messages from CMS.  First and second messages must be no longer than 200 characters (inclusive of spaces) and third and fourth messages must be no longer than 250 characters (inclusive of spaces).   Current messages for this subsection, previously known as General Information Messages from Med icare, can be found on the CMS website: http://www.cms.gov/Medicare/Medicare -General -Information/MSN/index.html.  The first sentence, or the phrase up to the punctuation, will be bolded depending on the message.  Specific detail on where to bold will be provided by the CR of the variable messages.   10.3.6 - Specifications for Section 3: Claims (Rev.4007, Issued: 03- 22-18, Effective: 07- 01-18. Implementation: 07- 02-18)  A. Section Title  POSITION   This subsection contains information of a fixed size.  It is fi xed in width but may vary in overall length.   The content area begins (0, 0.22), 7 points from the baseline of the content described above under the Headers for Other Pages subsection. It is full -page or 540 points in width and variable in height.     FORMATTING   [GR 2.1] black rule  [TH 2] section header   DYNAMIC RULES   The language in this section varies for different members of the extended family of MSNs. See the specific content specifications below for details.   When there is a combined MSN for Part A, order the claims as follows:   Part A Inpatient   B of A   Home Health   Hospice   When there is a combined MSN for Part B or DME, order the claims as follows:   Assigned   Unassigned   PART A INPATIENT SPECIFICATIONS   CONTENT   Your Inpatient Claims for Part A (Hospital Insurance)   HOSPICE SPECIFICATIO NS  CONTENT   Your Hospice Claims for Part A (Hospital Insurance)   HOME HEALTH SPECIFIC ATIONS   CONTENT   Your Home Health Claims for Part A (Hospital Insurance)   PART B ASSIGNED AND DME ASSIGNED SPECIFI CATIONS   CONTENT   Your Claims for Part B (Medical Insurance)   PART B UNASSIGNED AN D DME UNASSIGNED SPE CIFICATIONS   CONTENT   Your Unassigned Claims for Part B (Medical Insurance)   B OF A  SPECIFICATIONS   CONTENT   Your Outpatient Claims for Part B (Medical Insurance)   B. Definitions of Columns   GLOBAL SPECIFICATION S  POSITION
(Medicare Claims Processing Manual)
CONTENT   Your Unassigned Claims for Part B (Medical Insurance)   B OF A  SPECIFICATIONS   CONTENT   Your Outpatient Claims for Part B (Medical Insurance)   B. Definitions of Columns   GLOBAL SPECIFICATION S  POSITION   The subsection usually begins (0, 0.94) or 28 points from the baseline of the Section Title subsection.  The content area is full -page or 540 points in width but is divided into two columns, each column 259 points in width with 22 point gutter in between.  The height is variable, depending on the length of the content, which is determined by the member of the extended family to which the MSN belongs.  The left column should always be longer than the right column.  If a definition is split between the columns, there should be at least two lines on both left and right columns.    FORMATTING   [TB 1.1] first paragraph and body text of subsequent paragraphs  [GR 6] space between paragraph  [TH 3] column- definition title  [GR 6] space between paragraph  [TB 1.2] definition terms, through colon [TB 1.1] definition  NOTE:  The column header is bolded with the rest of the type usually in regular Roman text.  There are a few instances where there may be additional bolded words within the body text.  DYNAMIC RULES   The language in this section differs for each member of the extended family of MSNs.  See the specific content specifications below for details.   PART A INPATIENT SPECIFICATIONS   CONTENT   Part A Inpatient Hospital Insurance helps pay for inpatient hospital car e, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care.  Definitions of Columns   Benefit Days Used: The number of covered benefit days you used during each hospital and/or skilled nursing facility stay.   (See page 2 for more information and a summary of your benefit periods.)   Claim Approved?: This column tells you if Medicare covered the inpatient stay.   Non-Covered Charges: This is the amount Medicare didnt pay.   Amount Medicare Paid: This is the amou nt Medicare paid your inpatient facility.   Maximum You May Be Billed: The amount you may be billed for Part A services can include a deductible, coinsurance based on your benefit days used, and other charges.   For more information about Medicare Part A cov erage, see your Medicare & You handbook.  HOSPICE SPECIFICATIO NS  CONTENT
(Medicare Claims Processing Manual)
For more information about Medicare Part A cov erage, see your Medicare & You handbook.  HOSPICE SPECIFICATIO NS  CONTENT   Part A Hospital Insurance helps pay for inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care.   Defin itions of Columns   Service Approved?: This column tells you if Medicare covered the hospice service.   Amount Provider Charged: This is your providers fee for this service.   Medicare -Approved Amount : This is the amount a provider can be paid for a Medicare service.  It may be less than the actual amount the provider charged.  Your provider has agreed to accept this amount as full payment for covered services.  Medicare usually pays 80% of the Medicare -approved amount.  Amount Medicare Paid : This is the amou nt Medicare paid the provider.  This is usually 80% of the Medicare -approved amount.   Maximum You May Be Billed : This is the total amount the provider is allowed to bill you. This is usually $0, but can include copayments for outpatient prescription drugs, as well as 5% of the Medicare-  approved amount for inpatient respite care.  If you have Medicare Supplement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount.   HOME HEALTH SPECIFIC ATIONS   CONTENT   Part A Hospital Insuran ce helps pay for inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care.   Definitions of Columns   Service Approved?: This column tells you if Medicare covered the home health service.  Amount Provider Charged: This is your providers fee for this service.   Medicare -Approved Amount : This is the amount a provider can be paid for a Medicare service.  It may be less than the actual amount the provider charged.  Your provider has agreed to accept this amount as full payment for covered services.  Medicare usually pays 80% of the Medicare -approved amount.  Amount Medicare Paid : This is the amount Medicare paid the provider.  This is usually 80% of the Medicare -approved amount.   Maximum Yo u May Be Billed : This is the total amount the provider is allowed to bill you. This is usually $0. For durable medical equipment, it can include 20% of the Medicare- approved amount.  If you have Medicare Supplement Insurance (Medigap policy) or other insur ance, it may pay all or part of this amount.
(Medicare Claims Processing Manual)
PART B ASSIGNED SPEC IFICATIONS   CONTENT   Part B Medical Insurance helps pay for doctors services, diagnostic tests, ambulance services, and other health care services.   Definitions of Columns   Service Approved? : This column tells you if Medicare covered this service.  Amount Provider Charged : This is your providers fee for this service.   Medicare -Approved Amount : This is the amount a provider can be paid for a Medicare service.  It may be less than the actual amount the provider charged.  Your provider has agreed to accept this amount as full payment for covered services.  Medicare usually pays 80% of the Medicare -approved amount.  Amount Medicare Paid : This is the amount Medicare paid your provider.  T his is usually 80% of the Medicare -approved amount.   Maximum You May Be Billed : This is the total amount the provider is allowed to bill you, and can include a deductible, coinsurance, and other charges not covered.  If you have Medicare Supplement Insuran ce (Medigap policy) or other insurance, it may pay all or part of this amount.   PART B UNASSIGNED SPECIFICATIONS   CONTENT   Medicare claims may be assigned or unassigned. Your claims below are unassigned  - meaning the provider hasnt agreed to accept the Me dicare- approved amount as payment in full.  Do Unassigned Claims Cost More? Maybe. A provider who doesnt accept assignment may charge you up to 15% over the Medicare -approved amount.  This is known as the limiting charge .  You may have to pay this amount, or it may be covered by another insurer.   For a list of providers that always accept Medicare assignment , visit www.medicare.gov/physician or call 1 -800-MEDICARE (1 -800-633- 4227).  You may save money by choosing providers who accept assignment.   Definitions of Columns   Service Approved? : This column tells you if Medicare covered the service.  Amount Provider Charged : This is your providers fee for this service.   Medicare -Approved Amount : This is the amount a provider can be paid for a Medicare service. S ince your provider hasnt agreed to accept assignment, you might be charged up to 15% more than this amount.  Medicare usually pays 80% of the Medicare- approved amount.  Medicare Paid You : When a provider doesnt accept assignment, Medicare pays you directly.  Youll usually get 80% of the Medicare -approved amount.
(Medicare Claims Processing Manual)
Medicare Paid You : When a provider doesnt accept assignment, Medicare pays you directly.  Youll usually get 80% of the Medicare -approved amount.   Maximum You May Be Billed : This is the total amount the provider is allowed to bill you and can include a deductible, coinsurance, and other charges not covered.  If you have Medicare Supp lement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount.   B OF A  SPECIFICATIONS   CONTENT   Part B Medical Insurance helps pay for outpatient care provided by certified medical facilities, such as hospital outpatient dep artments, renal dialysis facilities, and community health centers.  Definitions of Columns   Service Approved?: This column tells you if Medicare covered the outpatient service.   Amount Facility Charged: This is the facilitys fee for this service.   Medicare -Approved Amount : This is the amount a facility can be paid for a Medicare service.  It may be less than the actual amount the facility charged.  The facility has agreed to accept this amount as full payment for covered services.  Medicare usually pays 80% of the Medicare -approved amount.  Amount Medicare Paid : This is the amount Medicare paid the facility.  This is usually 80% of the Medicare -approved amount.   Maximum You May Be Billed : This is the total amount the facility is allowed to bill you, and c an include a deductible, coinsurance, and other charges not covered.  If you have Medicare Supplement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount.   DME ASSIGNED SPECIFI CATIONS   CONTENT   Part B Medical Insurance help s pay for durable medical equipment and other health care services.   Definitions of Columns   Item/Service Approved? : This column tells you if Medicare covered this item or service.   Amount Supplier Charged: This is your suppliers fee for this item or service.   Medicare -Approved Amount : This is the amount a supplier can be paid for a Medicare item or service.  It may be less than the actual amount the supplier charged.  Your supplier has agreed to accept this amount as full payment for covered items or services.  Medicare usually pays 80% of the Medicare -approved amount.   Amount Medicare Paid : This column shows the amount Medicare paid the supplier.  This is usually 80% of the Medicare -approved amount.
(Medicare Claims Processing Manual)
Amount Medicare Paid : This column shows the amount Medicare paid the supplier.  This is usually 80% of the Medicare -approved amount.  Maximum You May Be Billed : This is the total amount the supplier is allowed to bill you, and can include a deductible, coinsurance, and other charges not covered.  If you have Medicare Supplement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount.   DME UNASSIGNED SPECI FICA TIONS   CONTENT   Medicare claims may be assigned or unassigned.  Your claims below are unassigned  - meaning the supplier hasnt agreed to accept the Medicare- approved amount as payment in full.  Do Unassigned Claims Cost More? Maybe. A supplier who doesnt accept assignment may charge you up to 15% over the Medicare -approved amount.  This is known as the limiting charge .  The limiting charge applies only to certain Medicare-covered services and doesnt apply to some supplies and durable medical equipment.  You may have to pay this amount, or it may be covered by another insurer.   For a list of suppliers that always accept Medicare assignment , visit www.medicare.gov/supplier or call 1- 800-MEDICARE (1 -800-633- 4227).  You may save money by choosing suppliers who accept assignment.   Definitions of Columns   Service Approved? : This column tells you if Medicare covered the item or service.   Amount Provider Charged : This is your suppliers fee for this item or service.   Medicare -Approved Amount : This is the amount a supplier can be paid for a Medicare item or service.  It may be less than the actual amount the supplier charged.  Since your supplier hasnt agreed to accept assignment, you might be charged more than this amount (see Do Unassigned Claims Cost More to y our left).  Medicare usually pays 80% of the Medicare -approved amount.  Medicare Paid You : When a supplier doesnt accept assignment, Medicare pays you directly.  Youll usually get 80% of the Medicare -approved amount.   Maximum You May Be Billed : This is the total amount the supplier is allowed to bill you and can include a deductible, coinsurance, and other charges not covered.  If you have Medicare Supplement Insurance (Medigap policy) or other insurance, it may pay all or part of this amount.   For more i nformation about Medicare assignment, see your Medicare & You handbook.
(Medicare Claims Processing Manual)
For more i nformation about Medicare assignment, see your Medicare & You handbook.  C. Claim Header   GLOBAL SPECIFICATION S  This subsection contains the name and contact information for the provider and/or referrer of each claim.  It also lists the date (or dates) of service for the claim.  See Exhibit 2.5 for multiple examples of this section, showing provider and contact information variations among extended family members. See Exhibit 2.6 for multiple examples of claim headers indicating multiple dates of service .  The sort order for claims is determined by the date of service listed in this section.  Claims should be listed by earliest date of service, using the first date of service in a given claim.   For multiple claims with the same earliest date of service, the claims are sorted chronologically by last date of service.   For multiple claims with the same first and last date of service, the claims are sorted alphabetically by billing facility name, provider last name, or supplier name.   For multiple claims with the same first and last date of service and the same billing provider, the claims are sorted by Maximum You May be Billed Amount, with the claim with the lowest amount listed first.   POSITION   This subsection is full -page or 540 points in width and starts 19 points below the definitions of columns.  The height is variable, depending on the length of the content, which may be three or four lines high.   Indent in 8 points all around for content area.  Note: Space after the black rule should be 8 points, rathe r than the typical 6 points specified in the style sheet.  The facility/provider/supplier line has a maximum of 40 characters, same as on page 1 on the Facility/Provider/Supplier List subsection.  The phone number has a maximum of 30 characters, to include area code and/or any international numbers for U.S. terr itories.  The address line has a maximum of 80 characters.  If the address exceeds the maximum character limit, truncate the second address line to fit the address in one line.  The referred or ordering provider line also has a maximum of 40 characters.     PART A INPATIENT, HO SPICE, HOME HEALTH AND B OF A  SPECIFICATIONS   FORMATTING
(Medicare Claims Processing Manual)
PART A INPATIENT, HO SPICE, HOME HEALTH AND B OF A  SPECIFICATIONS   FORMATTING   [GR 1] gray fill  [GR 2.1] black rule  [TH 4] Claim Service Date  [GR 5] space after text  [TB 2.2] facility/provider name and telephone number  [TB 2.1] facility/provider addres s  [TB 2.1] referring provider   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).  Facility Name   Print the complete name of the inpatient facility, hospice facility or provider, or home health provider that filed the claim for services.   Facility Phone Number   Print the facility or providers 10- digit phone number, preceded by a comma to separate it from th e facility or provider 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 with the billing department of the facility or provider that filed the claim for services.  If a specific billing contact number is not available, print the primary phone number for the facility or provider.  If no phone number for the facility or provider is available, suppress this content element and its preceding comma.   Facility Address   Print the facility or providers street address, city, state abbreviation, and ZIP code +4. Insert a comma between the street address and city, and between the city and state abbreviation.   If available, print the physical ad dress of the facility or provider.  If the physical address is not available, print the mailing or billing address for the facility or provider.  If no address for the facility or provider is available, suppress this content element.  Referring Provider
(Medicare Claims Processing Manual)
Referring Provider   If the beneficiary was referred by a provider, print the providers full name here, preceded by the phrase Referred by. When printing a degree suffix (e.g., M.D.) with a name, place a period after the M and after the D. Referring physician name and an y suffix should be separated by a comma.   CONTENT   {Date(s) of Service}   {Facility/Provider Name}, {10 -digit phone number for facility/provider}  {Facility/Provider Street Address}{Facility/Provider State}{Facility/Provider ZIP+4}   Referred by {Provider Title}{Provider Given Name}{Provider Middle Initial}{Provider Family Name}   PART B (ASSIGNED AND  UNASSIGNED) SPECIFI CATIONS   FORMATTING   [GR 1] gray fill  [GR 2.1] black rule  [TH 4] Claim Service Date  [GR 5] space after text  [TB 2.2] provider name and telephone number  [TB 2.1] provider practice name and address  [TB 2.1] referring provider   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., O ctober 15, 2021 -  January 3 , 2022).  Provider Name   Print the complete name of the provider that filed the claim for services.  When printing a degree suffix (e.g., M.D.) with a name, place a period after the M and after the D.  The name and any suffix  should be separated by a comma.   Provider Phone Number
(Medicare Claims Processing Manual)
Provider Phone Number   Print the providers 10- digit phone number, preceded by a comma to separate it from the provider 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 with the billing department of the provider that filed the claim for services.  If a specific billing contact number is not available, print the primary phone number for the provider.  If no phone number for the provider is available, suppress this content element and its preceding comma.  Provider Practice Name and Address   If applicable, print the name of the practice or facility associated with the provider.  Print the providers st reet 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.   Whenever possible, the address that is printed should be the physical address of the provider.  If the physical address is not available, use the mailing or billing address for the provider.  If no address for the provider is available, suppress this content element.  Referring Provider   If the beneficiary was referred to the provider by an other provider, print the referring providers full name here, preceded by the phrase Referred by.  When printing a degree suffix (e.g., M.D.) with a name, place a period after the M and after the D.  Referring provider name and any suffix should be separated by a comma.   CONTENT   {Date(s) of Service}   {Provider Title}{Provider Given Name}{Provider Middle Initial}{Provider Family Name} {, Provider Suffix}, {10 -digit phone number for provider}   {Provider Practice Name}{Provider Street Address}{ Provide r State}{ Provider ZIP+4}   Referred by {Provider Title}{Provider Given Name}{Provider Middle Initial}{Provider Family Name}   DME (ASSIGNED AND UN ASSIGNED) SPECIFICAT IONS   FORMATTING  [GR 1] gray fill  [GR 2.1] black rule  [TH 4] Claim Service Date  [GR 5] space after text  [TB 2.2] supplier name and telephone number  [TB 2.1] supplier practice name and address and any referring/ordering provider   DYNAMIC RULES   The content in this section is nearly entirely dynamically generated. It includes the following content elements:   Date(s) of Service