Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Comment Description 121 122 123 124 125 NONAGED RXHCC65 NONAGED RXHCC75 NONAGED RXHCC78 NONAGED RXHCC79 NONAGED RXHCC80 1 164 1 165 1 166 1 167 1 168 Set to "1" if applicable, otherwise "0" Set to "1" if applicable, otherwise "0" Set to "1" if applicable, otherwise "0" Set to "1" if applicable, otherwise "0" Set to "1" if applicable, otherwise "0" Non-Aged and Autism Non-Aged and Multiple Sclerosis Non-Aged and Intractable Epilepsy Non-Aged and Epilepsy and Other Seizure Disorders, Except Intractable Epilepsy Non-Aged and Convulsions Total Length = 168 NOTE: Fields 113-125 are associated with the Rx HCC Continuing Enrollee Institutional Score only. F.13.3 Trailer Record The Contract Trailer Record signals the end of the detail/Beneficiary records for a MA or stand-alone PDP contract. This record has a length of 164. Item Field Size Position Comment Description 1 2 3 Record Type Code Contract Number Total Record Count 1 1 Set to "3" 5 2-6 9 7-15 1 = Header 2 = Details 3 = Trailer Unique identification for a Managed Care Also known as Organization (MCO) enabling the MCO to provide MCO plan number coverage to eligible beneficiaries. Includes all header and trailer records Record count in display format 9(9). 4 Filler 153 16-168 Spaces Filler Total Length = 168 December 28, 2012 F-80 RAS RxHCC Model Output Data File
Plan Communications User Guide Appendices, Version 6.3 F.14 Daily Transaction Reply Report (DTRR) Data File The DTRR is created each evening, Monday through Saturday, and is available for Plans the following business day. All Plans receive a DTRR for all contracts whether the Plan has or has not submitted transactions for processing by MARx. The TRC of 000 indicates that there is no data within the DTRR for processing by the Plan. In turn, the Plan does not need to take any action and may discard this file. The file also contains records that report the submitted transactions verbatim back to the Plans (F.14.1). F.14.1 DTRR Data File Detailed Record Layout Item Field Size Position Description 1 HICN 12 1-12 Health Insurance Claim Number 2 Surname 12 13-24 Beneficiary Surname 3 First Name 7 25-31 Beneficiary Given Name 4 Middle Initial 1 32 Beneficiary Middle Initial 5 Gender Code 1 33 Beneficiary Gender Identification Code ‘0’ = Unknown; ‘1’ = Male; ‘2’ = Female. 6 Date of Birth 8 34-41 YYYYMMDD Format 7 Record Type 1 42 ‘T’ = TRC record 8 Contract 5 43-47 Plan Contract Number Number 9 State Code 2 48-49 Beneficiary Residence State Code; otherwise, spaces if not applicable. 10 County Code 3 50-52 Beneficiary Residence County Code; otherwise, spaces if not applicable. 11 Disability Indicator 12 Hospice Indicator 13 Institutional/NH C/HCBS Indicator 14 14. ESRD Indicator 15 15. Transaction Reply Code (TRC) 1 53 ‘1’ = Disabled; ‘0’ = No Disability; Space = not applicable. 1 54 ‘1’ = Hospice; ‘0’ = No Hospice; Space = not applicable. 1 55 ‘3’ = HCBS; ‘1’ = Institutional; ‘2’ = NHC; ‘0’ = No Institutional; Space = not applicable 1 56 ‘1’ = End-Stage Renal Disease; ‘0’ = No End-Stage Renal Disease; Space = not applicable. 3 57-59 TRC, see TRC list on page I-2 for values December 28, 2012 F-81 DTRR Data File
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I.3 Obsolete Transaction Reply Code
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CMS Transmittals to the Plans Plan
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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