Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Term Online Premium Premium Payment Option (PPO) Program for All Inclusive Care for the Elderly (PACE) Plans Radio button Required field Risk Special Needs Plan (SNP) Submenu TIBCO MFT Internet Server Transaction Code (TC) Transaction Reply Code (TRC) User ID User Interface Definition An automated systems approach that processes data in an interactive manner, normally through computer input. The monthly payment a Beneficiary makes to Medicare, an insurance company, or a healthcare Plan. The method selected by the beneficiary to pay the premium owed to the Plan. PPO choices are: (1) withhold from SSA (S) or RRB (R) benefit check or (2) Direct self-pay (D) to the Plan. PACE is a unique capitated managed care benefit for the frail elderly provided by a not-for-profit or public entity that features a comprehensive medical and social service delivery system. It uses a multidisciplinary team approach in an adult day health center supplemented by in-home and referral service in accordance with participants' needs. A field that is part of a group of options, of which the user may only select one option. A radio button is represented with a small circle; a filled circle indicates the button is selected, and an empty circle means it is not selected. Clicking a radio button selects that option and deselects the existing selection. A field that the user must complete before a button is clicked to engage an action. If the button is clicked and the field is not filled in, an error message displays and the action does not occur. There are two types of required fields: • Always required, which are marked with an asterisk (*) • Conditionally required, where the user must fill in at least one or only one of the conditionally required fields. These are marked with a plus sign (+). A contract under which Beneficiaries are “locked in” to network providers and a payment is received from CMS for each member, based on demographic characteristics and health status. In a Risk contract, the MCO accepts the risk if the payment does not cover the cost of services, but keeps the difference if the payment is greater than the cost of services. Risk is managed through a membership where the high costs for very sick members are balanced by the lower costs for a larger number of relatively healthy members. A certain type of MA Plan that serves a limited population of individuals in CMS special-needs categories, as defined in CMS Part C Enrollment and Eligibility Guidance. This Plan is fully defined on the Web at: http://www.cms.gov/home/medicare.asp under “Health Plans.” A horizontal list of items below the screen’s menu. Clicking on a submenu item displays a screen. The TIBCO MFT Internet Servers provide Electronic Data Interchange (EDI) capabilities between CMS and CMS business partners. These servers provide MARx and MBD with transaction files from the Plans, and provide the Plans with MARx and MBD reports. Identifies batch transactions submitted by the Plans or CMS. The code that explains the action taken by the system in response to new information from CMS systems or in response to input from MCOs, CMS, or other users. Valid user identification code for accessing the CMS Data Center and the Medicare Data Communications Network. The screens, forms, and menus that display to a user logged on to an automated system. December 28, 2012 A-3 Glossary and List of Abbreviations and Acronyms
Plan Communications User Guide Appendices, Version 6.3 A.1 List of Abbreviations and Acronyms AAPCC Adjusted Average Per Capita Cost ADAP AIDS Drug Assistance Program AE-FE Automated Enrollment-Facilitated Enrollment AEP Annual Enrollment Period APPS Automated Plan Payment System BBA Balanced Budget Act of 1997 BCSS Batch Completion Status Summary BEQ Beneficiary Eligibility Query BIC Beneficiary Identification Code BIN Beneficiary Identification Number BIPA Benefits Improvement & Protection Act of 2000 BSF Benefit Stabilization Fund CAN Claim Account Number CCIP/FFS Chronic Care Improvement Program/Fee-for-Service CCM Current Calendar Month C:D Connect:Direct CHF Congestive Heart Failure CM Center for Medicare CMP Competitive Medical Plan CMS Centers for Medicare & Medicaid Services CO Central Office COB Close of Business COB Coordination of Benefits COBA Coordination of Benefits Agreement COBC Coordination of Benefits Contractor COM Current Operation Month CPM Current Payment Month CR Change Request CSR Customer Service Representative CWF Common Working File database (CMS’ beneficiary database) DCG Diagnostic Cost Group DDPS Drug Data Processing System DO District Office DOB Date of Birth DOD Date of Death December 28, 2012 A-4 Glossary and List of Abbreviations and Acronyms
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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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