Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Item Field Position Length Type Description 69 Part C Premium Withholding Carry Over Amount 70 Part D Premium Withholding Carry Over Amount 71 Part D Low Income Premium Subsidy Carry Over Amount 72 Part D Late Enrollment Penalty Carry Over Amount 73 Education User Fee Carry Over Amount 74 Part D COB User Fee Carry Over Amount 75 CMS Special Adjustments Carry Over Amount 76 Total Carry Over Amount 47 – 59 13 Numeric Part C Premium Withholding Carry Over Amount from Table 5 ** - Previous Balance Column. Format: SSSSSSSSS9.99 60 – 72 13 Numeric Part D Premium Withholding Carry Over Amount from Table 5 ** - Previous Balance Column. Format: SSSSSSSSS9.99 73 – 85 13 Numeric Part D Low Income Premium Subsidy Carry Over Amount from Table 5 ** - Previous Balance Column. Format: SSSSSSSSS9.99 86 – 98 13 Numeric Part D Late Enrollment Penalty Carry Over Amount from Table 5 ** - Previous Balance Column. Format: SSSSSSSSS9.99 99 – 111 13 Numeric Education User Fee Carry Over Amount from Table 5 ** - Previous Balance Column. Format: SSSSSSSSS9.99 112 – 124 13 Numeric Part D COB User Fee Carry Over Amount from Table 5 ** - Previous Balance Column. Format:SSSSSSSSS9.99 125 – 137 13 Numeric CMS Special Adjustments Carry Over Amount from Table 5 ** - Previous Balance Column. Format: SSSSSSSSS9.99 138 – 150 13 Numeric Sum of amounts in Previous Balance Column Format: SSSSSSSSS9.99 77 Filler 151 – 200 50 Character Spaces. Total Length = 200 F.25.7 Payment Summary Item Field Position Length Type Description 78 Contract Number 79 Record Identification Code 80 Table ID Number 81 Part A Amount 1 – 5 5 Character Contract Number 6 – 6 1 Character Record Type Identifier A = Payment Summary Amounts included in this month’s payment from Tables 1 thru 4 plus Carry Over (from Previous Balance Column). 7 – 7 1 Character 5 8 – 20 13 Numeric Part A amount from Table 5 ** -Net Payment Column. Format: ZZZZZZZZZ9.99 December 28, 2012 F-134 PPR/IPPR Data File
Plan Communications User Guide Appendices, Version 6.3 Item Field Position Length Type Description 82 Part B Amount 21 – 33 13 Numeric Part B amount from Table 5 ** -Net Payment Column. Format: ZZZZZZZZZ9.99 83 Part D Amount 84 Part C Premium Withholding Amount 85 Part D Premium Withholding Amount 86 Part D Low Income Premium Subsidy Amount 87 Part D Late Enrollment Penalty Amount 88 Education User Fee Amount 89 Part D COB User Fee Amount 90 CMS Special Adjustments Amount 91 Total Net Payment 34 – 46 13 Numeric Part D amount from Table 5 ** -Net Payment Column. Format: ZZZZZZZZZ9.99 47 – 59 13 Numeric Part C Premium Withholding Amount from Table 5 ** -Net Payment Column. Format: ZZZZZZZZZ9.99 60 – 72 13 Numeric Part D Premium Withholding Amount from Table 5 ** -Net Payment Column. Format: ZZZZZZZZZ9.99 73 – 85 13 Numeric Part D Low Income Subsidy Amount from Table 5 ** -Net Payment Column. Format: ZZZZZZZZZ9.99 86 – 98 13 Numeric Part D Late Enrollment Penalty Amount from Table 5 ** -Net Payment Column. Format: SSSSSSSSS9.99 99 – 111 13 Numeric Education User Fee Amount from Table 5 ** - Net Payment Column. Format: SSSSSSSSS9.99 112 – 124 13 Numeric Part B COB Fee Amount from Table 5 ** -Net Payment Column. Format: SSSSSSSSS9.99 125 – 137 13 Numeric CMS Special Adjustments Amount from Table 5 ** -Net Payment Column. Format: SSSSSSSSS9.99 138 – 150 13 Numeric Sum of amounts in Net Payment Column. This is the plan’s Net Payment Amount for this month. If the amount is negative, the payment will be carried forward. Format: SSSSSSSSS9.99 92 Filler 151 – 200 50 Character Spaces. Total Length = 200 December 28, 2012 F-135 PPR/IPPR Data File
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Medicare Advantage and Prescription
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F.10.3 Trailer Record Plan Communic
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F.11.2 Record Type 2 Plan Communica
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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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