Medicare Advantage and Prescription Drug Plans December 28 ...

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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
Plan Communications User Guide Appendices, Version 6.3 Field Size Position creditable coverage; derived from MBQ_MARX_CRED_CVRG; ‘Y’, ‘N’, or ‘ ‘) Filler (This field is all spaces) 73 170-242 Part D Subsidy Level (This field identifies the portion of the Part D Premium subsidized; PTD_PRM_SBSDY_PCT in MBQ_LIS; For monthly, value is always ‘100’; For Facilitated, values are either ‘100’, ‘075’, ‘050’, or ‘025’) Co-Payment Category (This field indicates the Subsidy Co-Payment level for the beneficiary; LIS_COPMT_LVL_ID in MBQ_LIS; ‘1’ or ‘4’) Co-Payment Effective Date (The date the LIS begins; SBSDY_STRT_DATE in MBQ_LIS; For monthly, is always MMDDYYYY; For Facilitated, value is spaces) Beneficiary Address Line 1 (First line in the mailing address; BENE_LINE_1_ADR in MBD_BENE_ADR) Beneficiary Address Line 2 (Second line in the mailing address; BENE_LINE_2_ADR in MBD_BENE_ADR) Beneficiary Address Line 3 (Third line in the mailing address; BENE_LINE_3_ADR in MBD_BENE_ADR) Beneficiary Address Line 4 (Fourth line in the mailing address; BENE_LINE_4_ADR in MBD_BENE_ADR) Beneficiary Address Line 5 (Fifth line in the mailing address; BENE_LINE_5_ADR in MBD_BENE_ADR) Beneficiary Address Line 6 (Sixth line in the mailing address; BENE_LINE_6_ADR in MBD_BENE_ADR) Beneficiary Address City (The city in the mailing address; BENE_ADR_CITY_NAME in MBD_BENE_ADR) Beneficiary Address State (The state in the mailing address; ADR_PSTL_STATE_CD in MBD_BENE_ADR) Beneficiary Zip Code (The zip code in the mailing address; BENE_ADR_ZIP_CD in MBD_BENE_ADR) Full Last Name (This field provides the last name of the individual; BENE_LAST_NAME in MBD_BENE) Full First Name (This field provides the first name of the individual; BENE_1ST_NAME in MBD_BENE) Total Length = 615 3 243-245 1 246 8 247-254 40 255-294 40 295-334 40 335-374 40 375-414 40 415-454 40 455-494 40 495-534 2 535-536 9 537-545 40 546-585 30 586-615 December 28, 2012 F-127 Auto Assignment (PDP) Address Notification File
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Medicare Advantage and Prescription Drug Plans December 28 ...

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