Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Description 25 Part D Low-Income Premium Subsidy Level 26 Low-Income Co- Pay Category 3 235-237 1 238 Part D low-income premium subsidy category: ‘000’ = No subsidy Co-payment category: ‘0’ = none, not low-income 27 Filler 124 239-362 Spaces 28 ‘A’ = Approved SSA Applicant; LIS Source Code 1 363 ‘D’ = Deemed eligible by CMS 29 Filler 137 364-500 Spaces Total Length = 500 December 28, 2012 F-96 Loss of Subsidy Data File
Plan Communications User Guide Appendices, Version 6.3 F.18 LIS/Part D Premium Data File Field Size Position Description 1. Claim Number 12 1-12 Beneficiary’s CAN 2. Contract Number 5 13-17 Contract Identification Number 3. PBP Number 3 18-20 Beneficiary’s PBP ID, blank if none 4. Segment Number 3 21-23 Beneficiary’s Segment Identification Number, blank if none 5. Run Date 8 24-31 6. Subsidy Start Date 8 32-39 7. Subsidy End Date 8 40-47 8. Part D Premium Subsidy Percentage 9. Low-Income Co- Payment Level ID 10. Beneficiary Enrollment Effective Date 11. Beneficiary Enrollment End Date 12. Part C Premium Amount 13. Part D Premium Amount 14. Part D Late Enrollment Penalty Amount 3 48-50 1 51 8 52-59 8 60-67 8 68-75 8 76-83 8 84-91 15. LIS Subsidy Amount 8 92-99 16. LIS Penalty Subsidy Amount 17. Part D Penalty Waived Amount 18 Total Premium Amount 19. De Minimis Differential Amount 8 100-107 8 108-115 8 116-123 8 124-131 20. Filler 147 132- 278 Filler Total Length = 278 Data File Generation Date YYYYMMDD – Format Beneficiary’s Subsidy Start Date YYYYMMDD – Format Beneficiary’s Subsidy End Date YYYYMMDD – Format Beneficiary’s LIPS Percent ‘100’ = 100% Premium Subsidy ‘075’ = 75% Premium Subsidy ‘050’ = 50% Premium Subsidy ‘025’ = 25% Premium Subsidy Co-Payment Category Definitions: ‘1’=High; ‘2’=Low; ‘3’=$0; ‘4’=15% Beneficiary’s Enrollment effective date, YYYYMMDD – Format Beneficiary’s Enrollment End Date YYYYMMDD – Format Space can remain blank Beneficiary’s Part C Premium Amount (----9.99) Beneficiary’s Part D Premium Amount Net of De Minimis if Applicable, (----9.99) Beneficiary’s Part D LEP Amount (––9.99) Beneficiary’s LIS Subsidy Amount (----9.99) Beneficiary’s LIS Penalty Subsidy Amount, (----9.99) Beneficiary’s Part D Penalty Waived Amount, (----9.99) Total Calculated Premium for Beneficiary (----9.99) Amount by which a Part D De Minimis Plan’s beneficiary premium exceeds the applicable regional low-income premium subsidy benchmark. December 28, 2012 F-97 LIS/Part D Premium 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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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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