CMS Pub. 100-04, ch. 3, § 170.4

Processing

(Rev. 2654, Issued: 02-08-13, Effective: 05-09-13, Implementation, 05-09-13)

Beneficiaries are informed of all Medicare payment determinations, including those for

RNHCI services, via their monthly Medicare Summary Notice (MSN). The complete set

of messages used on the MSN can be found in chapter 21, section 50.42 of this manual.

The Medicare contractor with RHNCI specialty workload uses special messages on MSNs

to reflect determinations specific to the RNHCI benefit.

• If an RNHCI claim is denied because CWF did not find record of an RNHCI

election in the beneficiaries record, the contractor uses MSN message 42.3. This

message reads: “This service is not covered since you did not elect to receive

religious nonmedical health care services instead of regular Medicare services.”

• If an RNHCI claim is denied because CWF found record of an RNHCI election in

the beneficiary’s record that had been revoked in writing, the contractor uses MSN

message 42.5. This message reads: “This service is not covered because you

requested in writing that your election to religious nonmedical health care services

be revoked.”

• If an RNHCI claim is denied because CWF found record of an RNHCI election in

the beneficiary’s record that had been revoked because the beneficiary received

nonexcepted medical care, the contractor uses MSN message 42.4. This message

reads: “This service is not covered because you received medical health care

services which revoked your election to religious nonmedical health care services.”