Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Table I-2: Transaction Reply Codes Code Type Title Short Definition Definition 000 I No Data to Report 001 F Invalid Transaction Code 002 F Invalid Correction Action Code 003 F Invalid Contract Number NO REPORT BAD TRANS CODE BAD ACTION CODE BAD CONTRACT # This TRC can appear on both the Daily Transaction Reply Report (DTRR) and the Failed Payment Reply Report (FPRR) data files. On the TRR it indicates that none of the following occurred during the reporting period for the given contract/PBP, a beneficiary status change, user interface (UI) activity, or CMS or plan transaction processing. The reporting period is the span between the previous TRR and the current TRR. On the FPRR it indicates the presence of all prospective payments for the plan (contract/PBP), none are missing. Plan Action: None A transaction failed because the Transaction Code (field 16) contained an invalid value. Valid Transaction Code values are 01, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81. This transaction should be resubmitted with a valid Transaction Code. Note: Transaction Types 41 and 54 are valid but not submitted by the Plans. This TRC will be returned in the Batch Completion Status Summary (BCSS) Report along with the failed record and is not returned in the TRR. Plan Action: Correct the Transaction Code and resubmit if appropriate. A correction transaction (Transaction Type 01) failed because the supplied action code was an invalid value. The valid action code values are D, E, F and G. The transaction should be resubmitted with a valid action code. This TRC is returned in the Batch Completion Status Summary (BCSS) Report along with the failed record. This TRC is not returned in the TRR. Plan Action: Correct the Action Code and resubmit if appropriate. A transaction (Transaction Types 01, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81) failed because CMS did not recognize the contract number. This TRC is returned in the BCSS Report along with the failed record. This TRC is not returned in the TRR. Plan Action: Correct the Contract Number and resubmit if appropriate. December 28, 2012 I-3 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 004 R Beneficiary Name Required 006 R Incorrect Birth Date 007 R Invalid Claim Number 008 R Beneficiary Claim Number Not Found NEED MEMB NAME BAD BIRTH DATE BAD HICN FORMAT CLAIM NOT FOUND A transaction (Transaction Types 01, 41, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81) was rejected, because both of the beneficiary name fields (Surname and First Name) were blank. The beneficiary’s name must be provided. The transaction should be resubmitted with beneficiary name included. Plan Action: Populate the Beneficiary Name fields and resubmit if appropriate. A transaction (Transaction Types 01, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81) was rejected because the Birth Date, while non-blank and formatted correctly as YYYYMMDD (year, month, and day), is before 1870 or greater than the current year. The system tried to identify the beneficiary with the remaining demographic information but could not. Note: A blank Birth Date does not result in TRC 006 but may affect the ability to identify the appropriate beneficiary. See TRC 009. Plan Action: Correct the Birth Date and resubmit if appropriate. A transaction (Transaction Types 01, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, and 81) was rejected, because the beneficiary claim number was not in a valid format. The valid format for a claim number could take one of two forms: HICN is an 11-position value, with the first 9 positions numeric and the last 2 positions alphanumeric. RRB is a 7 to 12 position value, with the first 1 to 3 positions alpha and the last 6 or 9 positions numeric. Plan Action: Determine the correct claim number (HICN or RRB) for the beneficiary and resubmit the transaction if appropriate. A transaction (Transaction Types 01, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, and 81) was rejected, because a beneficiary with this claim number was not found. The transaction should be resubmitted with a valid claim number. Plan Action: Determine the correct claim number (HICN or RRB) for the beneficiary and resubmit the transaction if appropriate. December 28, 2012 I-4 Transaction Reply Codes (TRCs)
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F.21.2 Detail Record (Transaction)
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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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Medicare Advantage and Prescription Drug Plans December 28 ...

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