US · guidance
CMS Pub. 100-04, ch. 21, § 30.3
Exhibits of MSNs in Spanish
Exhibit 3.1 - Spanish Part A, inpatient
Exhibit 3.2 - Spanish ‘B of A’
Exhibit 3.3 - Spanish Hospice
Exhibit 3.4 - Spanish Home Health (A)
Exhibit 3.5 - Spanish Part B, assigned
Exhibit 3.6 - Spanish Part B, unassigned
Exhibit 3.7 - Spanish DME, assigned
Exhibit 3.8 - Spanish DME, unassigned
Exhibit 3.9 - Spanish RRB Part B, assigned
Exhibit 3.10 - Spanish duplicate MSN header
Exhibit 3.11 - Spanish multiple deductible types on Part B MSN
Exhibit 3.12 - Spanish multiple deductible years and benefit days on a Part A Inpatient
and ‘B of A’ combined
Exhibit 3.13 - Spanish provider list with tag
Exhibit 3.14 - Spanish fee line with large amount and none remain benefit days
Exhibit 3.15 - Spanish adjusted claim
Exhibit 3.16 - Spanish Pay MSN
Exhibit 3.17 - Alternate language for SHIP Contact Info
History
(Rev. 3210, Issued: 03-03-15, Effective: 04-16-15. Implementation: 04-16-15)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c601c3aa18801110001d8fe6e792e58305e86c0b176e369d57c04f99e6a061b4
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