CMS Pub. 100-04, ch. 21, § 10.3.2

This information describes the overall format conventions for the MSN.

MSNs are a combination of fixed and variable length sections, using a range of different

typefaces and type styles, as well as a number of static graphic elements. For discussion

of the display in specific areas of the notice, see the technical specifications beginning in

section 10.3.3. MACs should establish page layout and page breaks as specified by these

instructions and exhibits.

A. Printing Requirements

MSN MACs must follow these instructions:

• Generate all MSN forms by a laser printer.

• Ensure that the MSN is printed on 8.5 by 11 inch paper, exclusive of perforated

marginal pin-feed tabs.

• Print duplex.

• Use black ink only on white paper.

• Use shading as required by the instructions and exhibits.

• Allow for coding necessary for mail sorting equipment (e.g., bar coding, aims

marks).

• Ensure any MAC’s notations placed on the MSN do not affect the design of the

MSN.

• Refer to the specifications and exhibits for placement of information on the MSN.

B. Page Margins and Layout

Use 0.5-inch outer margins on the notice with exceptions when noted in the instructions.

Alternate approved margins, 0.75-inch left and 0.25-inch right, may also be used when

extra space is needed for bar code placement.

The MSN pages use two different column layouts, full page and two-column.

Full-page layouts are 7.5 inches or 540 points wide with 0.5-inch margins on each side,

as stated above. The Notice title, Foreign Language Footer, Section Title, and Claims

section use this layout. This layout may be used on just a portion of a page, with the

remainder of the page content split across two columns.

Two-column layouts have two separate 259 point columns with a 22 point gutter

between, also with 0.5-inch margins on each side. The Summary section, Making the

Most of Your Medicare section, Claims definitions, and Appeals section use this layout.

In the specifications below, a given subsection may be described as being one-column

wide; this means that the subsection’s content runs within one column in a two-column

layout.

C. Type & Graphic Styles

The MSN uses two typefaces, Minion (serif) and CMS Myriad (sans serif) in Opentype

format. Minion is a standard system font. The CMS Myriad font is customized for CMS

use; the font file contains additional glyphs to be used in the MSN. (Font files may be

requested from CMS, or may be included with Chapter 21 on an enclosed CD.)

Type & Graphics Glossary:

Alignment: The positioning of text within the page margins. Alignment can be flush

left, flush right, justified, or centered. Flush left and flush right are sometimes referred to

as left justified and right justified.

Baseline: The imaginary line on which the majority of the characters in a typeface rest.

Body Text: The paragraphs in a document that make up the bulk of its content. The

body text should be set in an appropriate and easy-to-read face, typically at 10- or 12-point size.

Glyph: The word glyph is used differently in different contexts. In the context of

modern computer operating systems, it is often defined as a shape in a font that is used to

represent a character code on screen or paper. The most common example of a glyph is a

letter, but the symbols and shapes in a font like ITC Zapf Dingbats are also glyphs.

Header: The short lines of emphasized text that introduce detail information in the body

text that follows. Also the category of faces that are designed to work best in headline

text.

Italic: A slanting or script-like version of a face. The upright faces are often referred to

as Roman.

Leading (pronounced: ledding): The amount of space added between lines of text to

make the document legible. The term originally referred to the thin lead spacers that

printers used to physically increase space between lines of metal type. Most applications

automatically apply standard leading based on the point size of the font. Closer leading

fits more text on the page, but decreases legibility. Looser leading spreads text out to fill

a page and makes the document easier to read. Leading can also be negative, in which

case the lines of text are so close that they overlap or touch.

Letterspacing: Adjusting the average distance between letters in a block of text to fit

more or less text into the given space or to improve legibility. Kerning allows

adjustments between individual letters; letterspacing is applied to a block of text as a

whole. Letterspacing is sometimes referred to as tracking or track kerning.

Margin: The white spaces around text blocks. Margins typically need to be created on

the edges of a page, since most printers can't print to the very edge. White space also

makes a document look better and easier to read.

Point: A unit of measure in typography. There are approximately 72 points to the inch.

A pica is 12 points.

Point Size: The common method of measuring type. The distance from the top of the

highest ascender to the bottom of the lowest descender in points. In Europe, type is often

measured by the cap-height in millimeters.

Rule: A solid or dashed graphic line in documents used to separate the elements of a

page. Rules and other graphic devices should be used sparingly, and only for clarifying

the function of other elements on the page.

Sans Serif: A type face that does not have serifs generally a low-contrast design. Sans

serif faces lend a clean, simple appearance to documents.

Serif: Small decorative strokes that are added to the end of a letter's main strokes. Serifs

improve readability by leading the eye along the line of type.

Style: One of the variations in appearance, such as italic and bold, that make up the faces

in a type family.

In most instances, Myriad is used for headers and for beneficiary-specific and dynamic

information. Minion is typically used for instructional body text.

MSN MACs should:

• Use the exact type point sizes and leading in the specifications.

• Use uppercase and lowercase letters, as well as bold printing, throughout the

form, except as specifically noted in the specifications.

• Not print text in italic type. In instances where italic is typically used, as in

document titles, quotes are used instead (e.g., “Medicare & You” handbook).

See below for a list of the different type styles used in printing the MSN. The styles

described below will be referenced throughout the detailed section and subsection

specifications that follow. All elements can be assumed to be printed in 100% black,

unless otherwise noted.

The naming convention of the different style groups are based on usage. Type Header is

abbreviated to TH, Type Body to TB, Graphic style to GR, and Glyph to GL.

TYPE HEADER STYLES

Code Name Font Point

Size

Leading

TH 1.1 Notice Title Myriad Bold 25 pt 25 pt

TH 1.2 Notice Subtitle Myriad Regular 22 pt 25 pt

TH 1.3 Notice Subtitle Alternate Myriad Regular 18 pt 25 pt

TH 1.4 Notice Subtitle Alternate 2 Myriad Regular 17 pt 25 pt

TH 2 Section Name Myriad Bold 21 pt 22 pt

TH 3 Body Header Myriad Bold 14 pt 16 pt

TH 4 Claim Date Myriad Bold 16 pt 18 pt

TH 5.1 Claim Column Title Myriad Semibold 10 pt 10 pt

TH 5.2 Claim Column Maximum Myriad Bold 10 pt 10 pt

TYPE BODY STYLES

Code Name Font Point

Size

Leading

TB 1.1 Body Text Minion Regular 12 pt 15 pt

TB 1.2 Body Highlight Minion Bold 12 pt 15 pt

TB 1.3 Alternate Address Text 1 Minion Bold 11 pt 12 pt

TB 1.4 Alternate Address Text 2 Minion Bold 10 pt 11 pt

TB 2.1 Bene Data Text Myriad Regular 12 pt 15 pt

TB 2.2 Bene Data Highlight Myriad Bold 12 pt 15 pt

TB 3 Notice Title Tagline Minion Regular 11 pt 25 pt

GRAPHIC STYLES AND SPACING

D. Glyphs & Static Print Elements

There are several locations on the MSN that require the insertion of graphic elements.

Code Name Graphic Style Space Before Space After

GR 1 Gray Fill 15% tint of black N/A N/A

GR 2.1 Black Rule 2 pt black line 0 points 6 points

GR 2.2 Black Rule only 2 pt black line N/A N/A

GR 3.1 Dotted Rule 1 pt dotted line 7 points 6 points

GR 3.2 Dotted Rule 2 1 pt dotted line 0 points 7 points

GR 3.3 Dotted Rule 3 1 pt dotted line 5 points 7 points

GR 4.1 Space after header No rule 14 points 0 points

GR 4.2 Space after icon No rule 10 points 0 points

GR 5 Space after text No rule 7 points 0 points

GR 6 Space between

paragraphs

No rule 12 points 0 points

GR 7 Appeals Form White fill and 0.5 pt

black line all around box

N/A N/A

GR 8 Space after Notice

Title

No rule 17 points 0 points

FLASH IMAGE

Code Name Location Size Sample

GL 1 HHS Seal Page 1 72 pt x 72 pt

GL 2 Foreign-Language Footer Page 1 540 pt x 27 pt See section

10.3.3.J

GL 3 Check logo Pay MSN 540 pt x 27 pt See section

10.3.9.C

GL 4 Notice Title, Part A Pay MSN 540 pt x 27 pt See section

10.3.9.D

GL 5 Notice Title, Part B Pay MSN 540 pt x 27 pt See section

10.3.9.D

GL 6 Notice Title, Part A and Part B Pay MSN 540 pt x 27 pt See section

10.3.9.D

GL 7 HHS Seal for envelope Envelope 57.5 pt x 57.5

pt

GL 8 Envelope Liner Envelope See section

10.3.10.D

GL 9 RRB Logo Page 1 of

RRB Part

B MSNs

70 pt x 70 pt

GLYPHS

Smaller icons used in headers can be found in CMS Myriad font file as glyphs.

Code Name Location Size Character

Code

Sample

GL 9 Check This Notice Page 2 15 pt x 15 pt

GL 10 Report Fraud Page 2 15 pt x 15 pt

GL 11 Get Help Page 2 15 pt x 15 pt

GL 12 Benefit Period Page 2 15 pt x 15 pt

GL 13 Preventive Services Page 2 15 pt x 15 pt

GL 14 Messages from Medicare Page 2 15 pt x 15 pt

GL 15 Claims Continued Arrow Claims N/A

E. Language & Style Conventions

The MSN generally follows CMS conventions for style and language use. One MSN-

specific convention is noted below:

facility vs. provider vs. supplier

When describing the provider of the claimed services on an MSN, different terms are

used for the different ‘extended family’ members: Part A Inpatient and ‘B of A’ use

“facility,” Part B (assigned and unassigned) use “provider,” and DME notices (assigned

and unassigned) use “supplier.”

F. Organizing Principles for Specifications

The specifications that follow can be assumed to apply globally; when specifications vary

by extended family member, the specifications will indicate which instructions apply

globally and which relate to a particular member or members of the extended family.

The specifications are organized into chunks that relate to the individual subsections of

the notice. Each unit of specifications will typically contain:

POSITION

• Instructions relating to the position of the subsection and its elements. The

position coordinates are based on top and left edge of margin set as (0˝, 0˝).

Adjust measurement according to margins used.

• Dimensions of content area and spacing between subsections.

• Specifications per section, listed by page position: top, left column, then right

column.

FORMATTING

• All figures are style and layout examples. Any magenta guides are for layout

reference only and are not to be printed. Refer to exhibits for accurate printed

examples.

• Graphic example of subsection with type formats, graphic style and spacing used,

and the content to which those formats are applied.

• Line by line code containing type, graphic, and spacing styles.

DYNAMIC RULES

• Description of any dynamically generated content within the section, and what

rules should be applied to generate the content.

CONTENT

• Language and other specific content that should appear.

• General specifications are presented in Roman text. Type formats are indicated by

bracketed codes (e.g., [TH 1.1]). Content that should be replicated on the MSN is

presented in italic type; dynamic elements within the content are surrounded by

curly brackets, {like this}.

In addition to figures for each subsection, exhibits are available for full MSNs for the

base design family and worst-case scenarios. Reference will be made to corresponding

files as needed.