Get Mran Form

Filling out the Mran Form online is a straightforward process that ensures accurate reporting of Medicare claims. This guide will walk you through each section of the form, making it easier for you to complete it correctly.

Follow the steps to successfully complete the Mran Form online.

1. Press the ‘Get Form’ button to access the form. This will allow you to open the document in your preferred editor.
2. Begin with the Medicare paid date field. Enter the date when Medicare processed the payment as indicated on the Remittance Advice (RA) or Remittance Notice (RN).
3. In the provider name box, input the name of the billing provider exactly as listed on the RA or RN.
4. For the NPI/API field, enter the National Provider Identifier or Atypical Provider Identifier associated with the billing provider.
5. Fill in the Texas Provider Identifier (TPI) in the designated area, ensuring it matches the information on the RA or RN.
6. Input the Medicare ID of the billing provider in the appropriate space as shown on the Medicare or MAP RA or RN.
7. Provide the billing provider’s street address, city, state, and ZIP code in their respective fields.
8. Enter the bill type from the Medicare or MAP RA or RN, noting that it may differ from the type of bill on the claim form.
9. Indicate the date range for services by entering the first date of service (DOS) and the last DOS in MM/DD/YYYY format.
10. In the client last name field, enter the patient's last name as noted on the Medicare or MAP RA or RN.
11. Fill out the client's first name field with the patient's first name from the corresponding RA or RN.
12. Insert the patient's Medicare Health Insurance Claim (HIC) number as listed on the Medicare or MAP RA or RN.
13. Enter the Medicare Internal Control Number (ICN) provided on the Medicare or MAP RA or RN.
14. Provide the total charges as noted on the Medicare or MAP RA or RN in the total charges field.
15. Fill in the covered charges with the amounts indicated on the Medicare or MAP RA or RN.
16. List any non-covered charges with the corresponding reason code as provided in the RA or RN.
17. Enter the deductible amount listed on the Medicare or MAP RA or RN.
18. If applicable, input the blood deductible as specified on the RA or RN for inpatient claims.
19. Fill in the coinsurance amount noted on the Medicare or MAP RA or RN.
20. Provide the amount paid by Medicare as specified on the RA or RN.
21. For the detail section, enter the relevant information like procedure code, units, charges, allowed amount, deductible, coinsurance, blood deductible, paid amount, and reason code corresponding to each service rendered.
22. Lastly, ensure you summarize any totals for charges, allowed amounts, deductibles, coinsurance, blood deductibles, and paid amounts as indicated on the RA or RN.
23. Once all information is accurately filled, you can save the changes, download the completed form, print it out, or share it as needed.

Complete your documents online today for efficient submission.