Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.30 No Premium Due Data File Layout
MA enrollees who elect optional supplemental benefits may also elect SSA premium
withholding. In mid-November, MARx begins preparing the premium records for the next year.
Since MARx cannot anticipate which optional premiums an enrollee may elect for next year, an
enrollee only paying optional premiums may convert from “SSA Premium Withholding” status
in one year to “No Premium Due” status for the next year. Plans should use the No Premium Due
Data File to identify enrollees in a “No Premium Due” status for the next year. Plans should
review the report and submit both a Part C Premium Update (TC 78) to update the Part C
premium Amount, and a PPO Update (TC 75) to request SSA Withholding Status, for enrollees
who are renewing both elections for the next year.
Field Size Position Description
HICN 12 1-12 Health Insurance Claim Number
Surname 12 13-24 Beneficiary Surname
First Name 7 25-31 Beneficiary Given Name
Middle Initial 1 32 Beneficiary Middle Initial
Gender Code 1 33 Beneficiary Gender Identification Code
‘0’ = Unknown;
‘1’ = Male;
‘2’ = Female.
Date of Birth 8 34-41 YYYYMMDD – Format
Filler 1 42 Space
Contract Number 5 43-47 Plan Contract Number
State Code 2 48-49 Spaces
County Code 3 50-52 Spaces
Disability Indicator 1 53 Space
Hospice Indicator 1 54 Space
Institutional/NHC Indicator 1 55 Space
ESRD Indicator 1 56 Space
TRC 3 57-59 TRC Defaulted to ‘267’
Transaction Code 2 60-61 TC Defaulted to ‘01’ for special reports
Entitlement Type Code 1 62 Space
Effective Date 8 63-70 YYYYMMDD – Format; Example: 20110101 (set to first
of January of the upcoming year)
WA Indicator 1 71 Space
PBP ID 3 72-74 PBP number
Filler 1 75 Space
Transaction Date 8 76-83 YYYYMMDD – Format; Set to the report generation date.
UI Initiated Change Flag 1 84 Space
FILLER 12 85-96 Spaces
District Office Code 3 97-99 Spaces
Previous Part D Contract/PBP 8 100-107 Spaces
for TrOOP Transfer.
End Date 8 108-115 Spaces
Source ID 5 116-120 Spaces
Prior PBP ID 3 121-123 Spaces
Application Date 8 124-131 Spaces
December 28, 2012 F-150 No Premium Due Data
File Layout