Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.25.2
Capitated Payment – Current Activity
Item Field Position Length Type Description
7 Contract
Number
1-5 5 Contract Number
8 Record
Identification
Code
9 Table ID
Number
10 Adjustment
Reason Code
6 1 Record Type Identifier
C = Capitated Payment
7 1 1
8-9 2 Blank = for prospective pay
For list of adjustment reasons codes consult
section H.3 of the Medicare Advantage and
Prescription Drug Plan Communication Guide.
11 Part A Total
Members
12 Part B Total
Members
13 Part D Total
Members
14 Part A Payment
Amount
10-17 8 Numeric Number of beneficiaries Part A payments is being
made prospectively.
Format: ZZZZZZZ9
18-25 8 Numeric Number of beneficiaries Part B payments is being
made prospectively.
Format: ZZZZZZZ9
26-33 8 Numeric Number of beneficiaries Part D payments is being
made prospectively.
Format: ZZZZZZZ9
34-46 13 Numeric Total Part A Amount
Format: SSSSSSSSS9.99
15 Part B Payment
Amount
47-59 13 Numeric Total Part B Amount
Format: SSSSSSSSS9.99
16 Part D Payment
Amount
60-72 13 Numeric Total Part D Amount
Format: SSSSSSSSS9.99
17 Coverage Gap
Discount
Amount
73-85 13 Numeric The Coverage Gap Discount included in Part D
Payment.
Format: SSSSSSSSS9.99
18 Total Payment 86- 98 13 Numeric Total Payment
Format: SSSSSSSSS9.99
19 Filler 99-200 102 Character Spaces
Total Length = 200
December 28, 2012 F-130 PPR/IPPR Data File