CMS Pub. 100-04, ch. 21, § 10.1

A. A/B MAC (A)/(HHH) MSN

The MSN is used to notify Medicare beneficiaries of action taken on A/B MAC

(A)/(HHH) processed claims. MSNs are not used by A/B MACs (HHH) for RAPs, and

RAP data are not included on the monthly MSN.

The MSN provides the beneficiary with a record of services received and the status of

any deductibles. The MSN also informs the beneficiary of appeal rights. The Balanced

Budget Act of 1997 requires all Part A benefit notices to include the amount of

Medicare payment for each service. A/B MACs (A) and (HHH), must furnish an MSN

to all beneficiaries for whom claims are filed during the month unless the situation is

specifically excluded by other manual instructions. MACs shall issue No-Pay MSNs on

a 180-day mailing cycle. MSNs with a payment check to the beneficiary shall continue

to be mailed out as processed. No-pay MSNs are defined as those MSNs which do not

require payment to the beneficiary for the respective claim(s).

The MSN replaced the following documents:

• Form CMS-1533, Part A Medicare Benefit Notice, also known as the Part A

Notice of Utilization (NOU) sent for inpatient services;

• Form CMS-1954, Benefit Denial Letter (BDL), sent for partially denied claims;

and

• Form CMS-1955, BDL sent for totally denied claims.

Since CMS eliminated BDLs, Medicare beneficiaries receive the information previously

conveyed on BDLs through narrative messages contained on the MSN. Providers no

longer receive a separate written notification or copy of the BDL. Providers must utilize

the coding information (e.g., ANSI Reason Codes) conveyed on the financial remittance

advice to ascertain reasons associated with Medicare claims determinations affecting

payment and applicable appeal rights and/or appeals information.