The Part B/Part B-DME Claim based Electronic Medicare Summary Notice displays information on a selected Part B claim, from the Claim Results page.

Below are explanations for each field shown on the Claim Details page:

• Claim Type - Type of claim (Medical Insurance)
• Disclaimer - Reminds the beneficiary that this eMSN is not the original MSN
• Facility Name - The name of the facility where the service took place
• Beneficiary Name - Name of beneficiary of the claim
• Provider Billing Address - The billing address of the provider that performed the service
• Provider Street Address - The billing address of the provider that performed the service
• Medicare Number - Medicare number of beneficiary
• Date Notice Printed - Date notice was printed
• Date Claim Processed - Date claim was processed
• Your Deductible Status - Status of the amount you must pay before Medicare begins to pay
• Be Informed! - Notice to the beneficiary to register at www.MyMedicare.gov for direct access to all original claims
• Your Cost for this Claim - Whether or not Medicare approved all claims, and the total you may be billed
• Facility for this Claim - The date the service began and ended, and the name of the facility where the service took place

Making the Most of Your Medicare

• How to Check This Notice?
• Do you recognize the name of each facility?
• Did you get the services listed?
• If you already paid the bill, did you pay the right amount?
• How to Report Fraud - Detailed explanation to report a fraudulent business or facility
• How to Get Help With Your Questions - Phone numbers to ask any questions regarding the eMSN
• Your Benefit Periods - The amount of days you spent in a hospital or skilled nursing facility (SNF)
• Your Messages from Medicare - Important messages from Medicare to the beneficiary

Your Inpatient Claim for Part B (Medical Insurance)

• Start Date - The date of that service for this claim started
• End Date - The date that service for this claim ended
• Facility Name - The name of the facility where the service took place
Provider Billing Address - The billing address of the provider that performed the service
Provider Street Address - The billing address of the provider that performed the service
Service Approved? - Whether the service was covered by Medicare
Amount Provider Charged - This is your provider's fee for this service
Medicare Approved Amount - This is the the amount a provider can be paid for a Medicare service. It may be less than the actual amount the provider charged
Amount Medicare Paid - Total amount Medicare paid your inpatient facility
Maximum you may be billed - The total dollar amount that the beneficiary is responsible for paying. This amount includes deductibles, co-insurance and/or charges for services or supplies that are not covered by Medicare
See Notes Below - Any notes for this claim

How to Handle Denied Claim or File an Appeal

• Get More Details - Gives phone number for any further details needed by beneficiary about their claim
• If You Disagree with a Coverage Decision, Payment Decision, or Payment Amount on this Notice, You Can Appeal - Explanation of how to appeal
• If You Need Help Filing Your Appeal - Medicare phone number listing along with other options to help the beneficiary in filing their appeal
Find Out More About Appeals - Refers beneficiary to "Medicare & You" handbook along with website www.medicare.gov/appeals, to learn more about appeals
File an Appeal in Writing - List of eight steps the beneficiary must follow in order to successfully file an appeal in writing

Please Note: The eMSN is not a bill, please visit MyMedicare.gov to access your original Medicare claims.

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