Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.24.2 Detail Record
Field Size Position
Beneficiary’s HICN (This field provides the HICN for identification of the
individual; RRB_HIC_NUM in MBD_BENE)
Beneficiary’s Last Name (This field provides the first twelve characters of
the last name of the individual; BENE_LAST_NAME in MBD_BENE)
Beneficiary’s First name (This field provides the first seven characters of
the first name of the individual; BENE_1ST_NAME in MBD_BENE)
Beneficiary’s Middle Initial (This field provides the middle initial of the
individual; MDL_INITL_NAME in MBD_BENE)
Beneficiary’s Gender (This field provides the gender of the individual;
BENE_SEX_CD in MBD_BENE; ‘0’, ‘1’, or ‘2’)
Beneficiary’s DOB (This field provides the date of birth of the individual in
CCYYMMDD format; BENE_BIRTH_DT in MBD_BENE)
Medicaid Indicator (This field indicates the beneficiary’s Medicaid
eligibility; MDCD_ELGBL_STUS_SW in MBQ_DUAL_MDCR; ‘Y’ or
‘N’)
Contract Number (This field provides the Contract assigned to the
beneficiary; ASGN_CNTRCT_NUM in MBQ_AA)
State Code (This field provides the beneficiary’s state of residency;
SSA_STD_STATE_CD in MBD_BENE_ADR)
County Code (This field provides the beneficiary’s county of residency;
SSA_STD_CNTY_CD in MBD_BENE_ADR)
12 1-12
12 13-24
7 25-31
1 32
1 33
8 34-41
1 42
5 43-47
2 48-49
3 50-52
Filler (This field is all spaces) 7 53-59
TC (This field identifies the type of record; ‘61’) 2 60-61
Filler (This field is all spaces) 1 62
Effective Date (The effective date of the assignment in CCYYMMDD
format; ASGN_EFCTV_DT in MBQ_AA)
8 63-70
Filler (This field is all spaces) 1 71
PBP (This field notes the PBP of the auto-assigned contract;
ASGN_PBP_NUM in MBQ_AA)
3 72-74
Filler (This field is all spaces) 49 75-123
Application Date (The date of the application in CCYYMMDD format) 8 124-131
Filler (This field is all spaces) 30 132-161
Election Type (This field indicates the type of election; ‘S’) 1 162
Enrollment Source (This field indicates the source of the enrollment; ‘A’) 1 163
Filler (This field is all spaces) 1 164
Premium Withhold Option/Parts C-D (This field indicates the payment
option for payment of Part C and D premiums; PRM_WTHLD_OPT_CD
in MBQ_PREMIUM; ‘D’)
1 165
Filler (This field is all spaces) 3 166-168
Creditable Coverage Flag (This field indicates if the beneficiary has 1 169
December 28, 2012 F-126 Auto Assignment (PDP)
Address Notification File