Medicare Summary Notice (MSN) and Remittance Advice (RA)

MSN 36.01:

Our records show that you were informed in writing, before receiving the service that Medicare would not pay. You are liable for this charge. If you do not agree with this statement, you may ask for a review. ASC X12 835, remittance advice remark code M38

MSN 36.02:

It appears that you did not know that we would not pay for this service so you are not liable. Do not pay your provider for this service. If you have paid your provider for this service, you should submit to this office three things 1) A copy of this notice, 2) Your provider’s bill, and 3) A receipt or proof that you have paid the bill. You must file your written request for payment within 6 months of the date of this notice. Future services of this type provided to you will be your responsibility. ASC X12 835 remittance advice remark code M25)

MSN 8.51:
You signed an Advanced Beneficiary Notice (ABN). You are responsible for the difference between the upgrade amount and the Medicare payment.

Use the following messages when denying claims due to invalid ABN upgrade information:

MSN 8.53:
This item or service was denied because the upgrade information was invalid.

MRN N108:
This item/service was denied because the upgrade information was invalid.
120.1 - Providing Upgrades of DMEPOS Without Any Extra Charge


Definitions of Modifiers that May be Associated with ABNs

GA - Waiver of Liability (expected to be denied as not reasonable and necessary, ABN on file)

GZ - Item or Service not Reasonable and Necessary (expected to be denied as not reasonable and necessary, no ABN on file)

GK - Reasonable and necessary item/service associated with GA or GZ modifier