Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
009 R No
beneficiary
match
011 A Enrollment
Accepted as
Submitted
013 A Disenrollmen
t Accepted as
Submitted
NO BENE
MATCH
ENROLL
ACCEPTED
DISENROL
ACCEPT
A transaction (Transaction Types 01, 51, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, and 81) attempted to
process but the system was unable to find the beneficiary based on the identifying information
submitted in the transaction.
A HICN is required, along with a match on 3 of the following 4 fields: surname, first initial, date of
birth and sex code.
Plan Action: Correct the beneficiary identifying information and resubmit if appropriate.
The new enrollment (Transaction Type 61) has been successfully processed. The effective date of
the new enrollment is reported in TRR data record field 18.
This is the definitive enrollment acceptance record. Other accompanying replies with different
TRCs may give additional information about this enrollment.
Plan Action: Ensure the Plan’s system matches the information included in the TRR record. Take
the appropriate actions as per CMS enrollment guidance.
A disenrollment transaction (Transaction Type 51) has been successfully processed. The last day of
the enrollment is reported in TRR data record fields 18 and 24.
The disenrollment date is always the last day of the month.
Plan Action: Ensure the Plan’s system matches the information included in the TRR record and
that the beneficiary’s disenrollment date matches the date in field 24. Take the appropriate actions
as per CMS enrollment guidance.
December 28, 2012 I-5 Transaction Reply Codes (TRCs)