Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.17 Loss of Subsidy Data File
This is a file sent to notify Plans about Beneficiaries’ loss of LIS deemed status for the following
calendar year based on CMS’ annual re-determination of deemed status or SSA’s redetermination
of LIS awards. The file is sent to Plans twice per year, once in September and
once in December.
The September file is informational only and is used to assist Plans in reaching out to the
affected population and encouraging them to file an application to qualify for the upcoming
calendar year.
The December file is for transactions and is used by Plans to determine who has lost the LIS as
of January 1 st of the coming year. The TRC is 996, which indicates the loss of the LIS. This
means the Beneficiary is not LIS eligible as of January 1 st of the upcoming year.
F.17.1 Loss of Subsidy Data File Detail Record
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 Filler 1 42 Spaces
8 Contract Number 5 43-47 Plan Contract Number
9 State Code 2 48-49 Beneficiary State Code
10 County Code 3 50-52 Beneficiary County Code
11 Filler 4 53-56 Spaces
12 TRC 3 57-59 TRC ‘996’
13 Transaction Type
Code
2 60-61 Transaction Type Code ‘01’
14 Filler 1 62 Spaces
15
YYYYMMDD – Format is 01/01 of the next year. Start
Effective Date 8 63-70
of Beneficiary’s Loss of LIS status.
16 Filler 1 71 Spaces
17 Plan Benefit
Package ID
3 72-74 PBP number
18 Filler 1 75 Spaces
19 Transaction Date 8 76-83 Set to Current Date (YYYYMMDD), is the run date.
20 Filler 1 84 Spaces
21 Low-Income
End Date of Beneficiary’s LIS Period (YYYYMMDD),
8 85-92
Subsidy End Date
is 12/31 of the current year.
22 Filler 42 93-134 Spaces
23 Segment Number 3 135-137 ‘000’ if no segment in PBP
24 Filler 97 138-234 Spaces
December 28, 2012 F-95 Loss of Subsidy Data File