Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
016 I Enrollment
Accepted,
Out Of Area
017 I Enrollment
Accepted,
Payment
Default Rate
018 A Automatic
Disenrollmen
t
019 R Enrollment
Rejected - No
Part A & Part
B Entitlement
ENROLL-OUT
AREA
ENROLL-BAD
SCC
AUTO
DISENROLL
NO ENROLL-NO
AB
The beneficiary’s residence state and county codes placed the beneficiary outside of the Plan’s
approved service area.
This TRC provides additional information about a new enrollment or PBP change (Transaction
Type 61) for which an acceptance was sent in a separate Transaction Reply record with an
enrollment acceptance TRC. The Effective Date of the enrollment for which this information is
pertinent is reported in TRR data record field 18.
Plan Action: Investigate the apparent discrepancy and take the appropriate actions as per CMS
enrollment guidance.
CMS was unable to derive a valid state and county code for the beneficiary who has been
successfully enrolled. Part C payment for this beneficiary is at the Plan bid rate with no geographic
adjustment.
This TRC provides additional information about a new enrollment or PBP change (Transaction
Type 61) for which an acceptance was sent in a separate Transaction Reply with an enrollment
acceptance TRC. The effective date of the new enrollment for which this information is pertinent is
reported in TRR data record fields 18 and 24.
Plan Action: Contact your CMS Central Office Health Insurance Specialist for assistance.
The beneficiary has been disenrolled from the Plan. The last day of enrollment is reported in TRR
data record fields 18 and 24. This date is always the last day of the month.
The disenrollment may result from an action on the part of the beneficiary, CMS or another Plan.
A TRR reply with this TRC is usually accompanied by one or more replies, which make the reason
for automatic disenrollment evident. For example, in the case of beneficiary death, the reply with
TRC 018 is accompanied by two replies with TRC 090.
Plan Action: Update the Plan’s records to reflect the disenrollment using the date in field 24. Take
the appropriate actions as per CMS enrollment guidance.
A submitted enrollment or PBP change transaction (Transaction Type 61) was rejected because the
beneficiary does not have Medicare entitlement as of the effective date of the transaction.
Plan Action: Take the appropriate actions as per CMS enrollment guidance.
December 28, 2012 I-7 Transaction Reply Codes (TRCs)