Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
014 A Disenrollmen
t Due to
Enrollment in
Another Plan
015 A Enrollment
Cancelled
DISNROL-NEW
MCO
ENROLL
CANCELED
This TRC is returned on a reply with the successful processing of Transaction Type 51
(disenrollment) and Transaction Type 61 (enrollment).
The last day of the enrollment is reported in TRR data record fields 18 and 24. This date will
always be the last day of the month.
For the Transaction Type 51 transaction, the beneficiary has been disenrolled from this Plan because
they were successfully enrolled in another Plan The Source ID (field 28) contains the Contract
number of the Plan that submitted the new enrollment which caused this disenrollment.
For the Transaction Type 61 transaction, the TRC is issued whenever a retroactive enrollment runs
into an existing enrollment that prevails according to application date edits. The Source ID (field 28)
contains the Contract number of the prevailing plan.
Plan Action: Update the Plan’s records accordingly, ensuring that the beneficiary’s information
matches the data 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.
An existing enrollment was cancelled. The effective date of the enrollment which has been
cancelled is reported in the TRR data record Effective Date field (18). This is always a
disenrollment Transaction Type 51.
A cancellation may be the result of an action on the part of the beneficiary, CMS or another Plan.
When an enrollment is cancelled, it means that the enrollment never occurred.
Plan Action: Because it was cancelled, this entire enrollment that was scheduled to begin on the
date in field 18 should be removed from the Plan’s enrollment records. Take the appropriate actions
as per CMS enrollment guidance.
December 28, 2012 I-6 Transaction Reply Codes (TRCs)