The Part A Hospital Inpatient Claim based Electronic Medicare Summary Notice displays information on a selected Part A claim, from the Claim Results page.
Below are explanations for each field shown on the Claim Details page:
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Claim Type - Type of claim (Hospital Insurance)
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Disclaimer - Reminds the beneficiary that this eMSN is not the original MSN
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Facility Name - The name of the facility where the service took place
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Beneficiary Name - Name of beneficiary of the claim
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Provider Billing Address - The billing address of the provider that performed the service
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Provider Street Address - The billing address of the provider that performed the service
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Medicare Number - Medicare number of beneficiary
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Date Notice Printed - Date notice was printed
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Date Claim Processed - Date claim was processed
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Your Deductible Status - Status of the amount you must pay before Medicare begins to pay
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Be Informed! - Notice to the beneficiary to register at
www.MyMedicare.gov for direct access to all original claims
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Your Cost for this Claim - Whether or not Medicare approved all claims, and the total you may be billed
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Facility for this Claim - The date the service began and ended, and the name of the facility where the service took place
Making the Most of Your Medicare
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How to Check This Notice?
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Do you recognize the name of each facility?
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Did you get the services listed?
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If you already paid the bill, did you pay the right amount?
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How to Report Fraud - Detailed explanation to report a fraudulent business or facility
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How to Get Help With Your Questions - Phone numbers to ask any questions regarding the eMSN
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Your Benefit Periods - The amount of days you spent in a hospital or skilled nursing facility (SNF)
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Your Messages from Medicare - Important messages from Medicare to the beneficiary
Your Inpatient Claim for Part A (Hospital Insurance)
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Start Date - The date of that service for this claim started
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End Date - The date that service for this claim ended
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Facility Name - The name of the facility where the service took place
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Provider Billing Address - The billing address of the provider that performed the service
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Provider Street Address - The billing address of the provider that performed the service
- Referred by - Name of physician who referred beneficiary for service
- Benefit Days Used - The number of full inpatient coverage hospital days used during the coverage period
- Claim Approved? - Whether or not the claim was approved by Medicare
- Total Non-Covered Charges - The total charges not covered by Medicare
- Amount Medicare Paid - Total amount Medicare paid your inpatient facility
- Maximum you may be billed - The total dollar amount that the beneficiary is responsible for paying. This amount includes deductibles, co-insurance and/or charges for services or supplies that are not covered by Medicare.
- See Notes Below - Any notes for this claim
How to Handle Denied Claim or File an Appeal
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Get More Details - Gives phone number for any further details needed by beneficiary about their claim
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If You Disagree with a Coverage Decision, Payment Decision, or Payment Amount on this Notice, You Can Appeal - Explanation of how to appeal
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If You Need Help Filing Your Appeal - Medicare phone number listing along with other options to help the beneficiary in filing their appeal
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Find Out More About Appeals - Refers beneficiary to "Medicare & You" handbook along with website
www.medicare.gov/appeals, to learn more about appeals
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File an Appeal in Writing - List of eight steps the beneficiary must follow in order to successfully file an appeal in writing
Please Note: The eMSN is not a bill, please visit MyMedicare.gov to access your original Medicare claims.
(FAQ6003)