Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Item Field Size Position Description
65 LIS Source
Code
66 Enrollee Type
Flag, PBP Level
67 Application
Date
Indicator
1 363 ‘A’ = Approved SSA applicant;
‘D’ = Deemed eligible by CMS;
Space = not applicable.
1 364 Designation relative to the report generation date (Transaction Date,
field #22)
‘C’ = Current PBP enrollee;
‘P’ = Prospective PBP enrollee;
‘Y’ = Previous PBP enrollee;
Spaces = not applicable.
1 365 Identifies whether the application date associated with a UI
submitted enrollment has a system generated default value:
‘Y’ = Default value for UI enrollment;
Space = Not applicable
15 366-380 TRC’s short-name identifier
68 TRC Short
Name
69 DRC 2 381-382 Disenrollment Reason Code, see DRC list for values
70 MMP Opt-Out
Flag
1 383 “Y” = Opted out of passive enrollment into an MMP
“N” = Not opted out of passive enrollment into MMP
Space = Not applicable
71 Filler 91 384-474 Spaces
72 System
11 475-485 System assigned transaction tracking ID.
Assigned
Transaction
Tracking ID
73 Plan Assigned
Transaction
Tracking ID
15 486-500 Plan submitted batch input transaction tracking ID.
Total Length = 500
December 28, 2012 F-88 DTRR Data File