Medicare Current Beneficiary Survey (MCBS):(CMS Number CMS-P-0015A)

Statement Charge Bundle Roster Pop-Up
Item #:

STATTYPE
Cheshire Name:

STE1005

COST.STATTYPE
Display response options in the following order:
1/Medicare
2/Insurance
4/Tricare
3/MedicareAndInsurance
5/MedicareAndTricare
6/TricareAndInsurance
7/MedicareAndTricareAndInsurance
8/MPDPBenefit

Field Type:
Type Name:
Answers Allowed:
Drop Down List:
Lookup File:
Lookup File Name:

Enumerated
TStattype

1

No
No

Number Label
1 Medicare
2

3

4

5
6

7

8

FieldSize:

Min Value:

Max Value:

Mask:

Route
STCharge - MCARTYPE ( STE1010 )

English text: MEDICARE SUMMARY NOTICE (MSN) ONLY
Insurance
Exit Pop-Up Window.
English text: INSURANCE STATEMENT ONLY
MedicareAndInsurance
STCharge - MCARTYPE ( STE1010 )
English text: BOTH MEDICARE SUMMARY NOTICE (MSN) AND INSURANCE
STATEMENTS
Tricare
Exit Pop-Up Window.
English text: TRICARE STATEMENT ONLY
MedicareAndTricare
STCharge - MCARTYPE ( STE1010 )
English text: BOTH MEDICARE SUMMARY NOTICE (MSN) AND TRICARE STATEMENTS
TricareAndInsurance
Exit Pop-Up Window.
English text: BOTH TRICARE AND INSURANCE STATEMENTS
MedicareAndTricareAndInsurance
STCharge - MCARTYPE ( STE1010 )
English text: MEDICARE SUMMARY NOTICE (MSN) AND TRICARE AND INSURANCE
STATEMENTS
MPDPBenefit
Exit Pop-Up Window
English text: MEDICARE PRESCRIPTION DRUG BENEFIT STATEMENT

11:47:36 AM Friday, November 14, 2008

Page 1 of 2

Statement Charge Bundle Roster Pop-Up
Item #:

MCARTYPE
Cheshire Name:

STE1010

COST.MCARTYPE
Do not display response options 1/ExplanationPartB,

2/MedicareBenefitNotice, 3/YourRecordOfPartB. These

response options have been retired.

Field Type:

Type Name:

Answers Allowed:

Drop Down List:

Lookup File:

Lookup File Name:

Enumerated
TMcartype
1
No
No

Number Label
1 ExplanationPartB

2

3

4

5

6

7

8

FieldSize:
Min Value:
Max Value:
Mask:

Route

DO NOT DISPLAY.
English text: EXPLANATION OF YOUR MEDICARE PART B BENEFITS (EXAMPLE 1)
MedicareBenefitNotice
DO NOT DISPLAY.
English text: MEDICARE BENEFIT NOTICE (EXAMPLE 2)
YourRecordOfPartB
DO NOT DISPLAY.
English text: YOUR RECORD OF PART B MEDICARE BENEFITS USED (EXAMPLE 3)
MsnPartB
Exit Pop-Up Window.
English text: MEDICARE SUMMARY NOTICE: PART B MEDICAL INSURANCE - ASSIGNED
OR UNASSIGNED CLAIMS (EXAMPLE 4)
MsnPartBOutpatient
Exit Pop-Up Window.
English text: MEDICARE SUMMARY NOTICE: PART B MEDICAL INSURANCE OUTPATIENT FACILITY CLAIMS (EXAMPLE 5)
MsnPartAInpatient
Exit Pop-Up Window.
English text: MEDICARE SUMMARY NOTICE: PART A HOSPITAL INSURANCE INPATIENT CLAIMS (EXAMPLE 6)
MsnPartAHomeHealth
Exit Pop-Up Window.
English text: MEDICARE SUMMARY NOTICE: HOME HEALTH CARE CLAIMS (EXAMPLE 7)
MsnPartAHospice
Exit Pop-Up Window.
English text: MEDICARE SUMMARY NOTICE: PART A HOSPICE FACILITY CLAIMS
(EXAMPLE 8)

11:47:40 AM Friday, November 14, 2008

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