Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 F.19 LIS History Data File (LISHIST) The Monthly LISHIST provides the most complete picture of LIS eligibility over a period not to exceed 36 months. This data file includes LIS activity for past, present, and future enrollees. Please note the following limitations: The LIS History Data File displays those LIS contract history changes during active, contiguous enrollment over a period of time not to exceed 36 months. Note: This file was updated to include a Data Activity Flag in field 16 (position 80) of the Detail Record. F.19.1 Header Record Item Field Size Position Format Description 1 Record Type 1 1 CHAR ‘H’ = Header Record 2 MCO Contract Number 5 2-6 CHAR 3 Data file Date 8 7-14 CHAR 4 Calendar Month 6 15-20 CHAR 5 Filler 145 21-165 CHAR SPACES Total Length = 165 Contract ID: 9xxxx, Exxxx, Fxxxx, Hxxxx, Rxxxx, or Sxxxx, where “xxxx” is the contract’s numeric designation. Date this data file created YYYYMMDD – Format First six digits contain Calendar Month the report generated; YYYYMMDD – Format December 28, 2012 F-98 LIS History Data File (LISHIST)
Plan Communications User Guide Appendices, Version 6.3 F.19.2 Detail Record (Transaction) Item Field Size Position Position Description 1 Record Type 1 1 CHAR ‘D’ = Detail Record 2 MCO Contract Number 5 2-6 CHAR Contract ID: 9xxxx, Exxxx, Fxxxx, Hxxxx, Rxxxx, or Sxxxx, where “xxxx” is the contract’s numeric designation. 3 PBP Number 3 7-9 CHAR PBP Number, blank when Beneficiary premium profile is unavailable. 4 HIC Number 12 10-21 CHAR Beneficiary’s HIC # 5 Surname 12 22-33 CHAR Beneficiary’s Surname 6 First Name 7 34-40 CHAR Beneficiary’s First Initial 7 Middle Initial 1 41 CHAR Beneficiary’s Middle Initial 8 Sex 1 42 CHAR M = Male, F = Female 9 Date of Birth 8 43-50 CHAR Date of Birth YYYYMMDD – Format 10 11 Low Income Period Start Date Low Income Period End Date 8 51-58 CHAR 8 59-66 CHAR 12 LIPS Percentage 3 67-69 CHAR 13 Premium LIS Amount 8 70-77 CHAR Start date for beneficiary’s Low Income Period Amount: YYYYMMDD – Format End date for beneficiary’s Low Income Period Amount: YYYYMMDD – Format Beneficiary’s LIPS Percentage ‘100’ = 100% Premium subsidy ‘075’ = 75% Premium subsidy ‘050’ = 50% Premium subsidy ‘025’ = 25% Premium subsidy The portion of the Part D basic premium paid by the Government on behalf of a low-income individual. A zero dollar amount here represents several possibilities: 1. There is no Plan premium and therefore no premium subsidy. 2. Although the Beneficiary is enrolled and LIS eligible, a system error occurred making premium data unavailable. Premium LIS Amount is entered in spaces when data is unavailable. 99999.99 – Format 14 Low Income Co-pay Level ID 1 78 CHAR Co-Payment Category Definitions: ‘1’ = High ‘2’ = Low ‘3’ = $0 ‘4’ = 15% Co-pay level IDs 1 and 2 change each year. In 2007, 1 = $2.15/$5.35 and 2 = $1/$3.10. In 2006 1 = $2/$5 and 2 = $1/$3. December 28, 2012 F-99 LIS History Data File (LISHIST)
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I.3 Obsolete Transaction Reply Code
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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