Line Item Instructions Form CMS-H751A/B - (Rev. 5, 08-30-02)

270 - Line Item Instructions Form CMS-H751A/B - (Rev. 5, 08-30-02) A1-1923, A1-1943, B1-4923, B1-4943 Medicare contractors must develop and maintain transaction level detail (at a minimum, this would include the provider name, provider number, date of determination, outstanding balance, and any adjustments or recoupments) by debt to support the amounts reported for each line outlined below. In addition, non-MSP amounts must be reconciled to the POR (intermediary) or PSOR (carrier) system as applicable. Part I, Status of Receivables For each line in Section A, below, the instruction applies to each the Form CMS-H751 and Form CMS-M751, and to the intermediary report and to the carrier report unless otherwise noted. The instructions are applicable only to MSP amounts for the Form CMS-M751 and are applicable to all amounts for the Form CMS-H751. Section A - Outstanding Receivables