MSN - Specifications for Header for Other Pages (Rev. 2522, 01-03-13(Final Implementation)

by  Jared Staheli
June 22nd, 2015

This element repeats at the top of every page of the MSN, except for the first page. It contains the beneficiary’s name, a notification, and page numbering.

POSITION

This subsection is of a fixed size. It does not vary in overall width or length.

It begins (0˝, 0˝) and is full-page or 540 points in width.

The first content unit, the beneficiary’s name, is flush left. The second content unit, containing the notification text and page numbering, is flush right.

DYNAMIC RULES

This section contains two dynamic elements, the beneficiary’s name and the page numbering.

The beneficiary’s name should be printed with the given name first, followed by any middle initial(s), the family name, then any suffixes (e.g., Jr.)

The page number indicator, in the format {Page # of #}, must include the number of the page on which the element appears and, in the second numeric position, the total page count for the notice.

CONTENT

{Beneficiary’s Given Name}{Beneficiary’s Middle Initials}{Beneficiary’s Family Name}{Beneficiary’s Suffix}

THIS IS NOT A BILL | {Page # of #}

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 21