Medicare Advantage and Prescription Drug Plans December 28 ...

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)