Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 I: Codes This appendix lists the numerical value and descriptions for codes that are highly visible to users. I.1 Transaction Codes Table I-1 lists the Medicare Advantage and Prescription Drug System (MARx) Transaction Codes and the description of each code. Table I-1: Transaction Codes Code Description 01 MCO Correction 30 Turn Bene-Level Demonstration Factor On (Demos Only) 31 Turn Bene-Level Demonstration Factor Off (Demos Only) 41 Update to Opt-Out Flag (Submitted by CMS) 42 MMP Opt-Out Change (Submitted by 1-800 MEDICARE) 51 Disenrollment (MCO or CMS) 54 Disenrollment (Submitted by 1-800-MEDICARE) 61 Enrollment 72 4Rx Record Update 73 NUNCMO Record Update 74 EGHP s Record Update 75 Premium Payment Option (PPO) Update 76 Residence Address Record Update 77 Segment ID Record Update 78 Part C Premium Record Update 79 Part D Opt-Out Record Update 80 Cancellation Enrollment 81 Cancellation Disenrollment 82 MMP Enrollment Cancellation 83 MMP Opt-Out Update December 28, 2012 I-1 Transaction Codes (TCs)
Plan Communications User Guide Appendices, Version 6.3 I.2 Transaction Reply Codes Table I-2 lists the reply codes returned for transactions found in Table I-1. Transaction Reply Code (TRC) Types: A - Accepted - A transaction is accepted and the requested action is applied (Example: enrollment or disenrollment) R - Rejected - A transaction is rejected due to an error or other condition. The requested action is not applied to the CMS System. The TRC indicates the reason for the transaction rejection. The Plan should analyze the rejection to validate the submitted transaction and to determine whether to resubmit the transaction with corrections. I - M - Informational - These replies accompany Accepted TRC replies and provide additional information about the transaction or Beneficiary. For example: If an enrollment transaction for a Beneficiary who is “out of area” is accepted, the Plan receives an accepted TRC (TRC 011) and an additional reply is included in the Transaction Reply Report (TRR) that gives the Plan the additional information that the Beneficiary is “Out of Area” (TRC 016). Maintenance - These replies provide information to Plans about the Beneficiaries enrolled in their Plans. They are sent in response to information received by CMS. For example: If CMS is informed of a change in a Beneficiary’s claim number, a reply is included in the Plan’s TRR with TRC 086, giving the Plan the new claim number. F - Failed - A transaction failed due to an error or other condition and the requested action did not occur. The TRC code indicates the reason for the transaction’s failure. The Plan should analyze the failed transaction and determine whether to resubmit with corrections. Legend for Type: A = Accepted R = Rejected I = Informational M = Maintenance F = Failed December 28, 2012 I-2 Transaction Reply Codes (TRCs)
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I.3 Obsolete Transaction Reply Code
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Medicare Advantage and Prescription Drug Plans December 28 ...

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