Medicare Advantage and Prescription Drug Plans December 28 ...

More documents

Recommendations

Info

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)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 020 R Enrollment Rejected - Under 55 022 A Transaction Accepted, Claim Number Change 023 A Transaction Accepted, Name Change NO ENROLL- NOT55 NEW HICN NEW NAME A submitted enrollment or PBP change transaction (Transaction Type 61) for a PACE plan was rejected because the beneficiary is not yet 55 years of age. Plan Action: Take the appropriate actions as per CMS enrollment guidance. A transaction (Transaction Types 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81) has been successfully processed. The effective date of the transaction is shown in TRR data file field 18. Additionally, the claim number for this beneficiary has changed. The new claim number is in TRR data file field 1 and the old claim number is reported in field 24. For enrollment acceptance (Transaction Type 61), TRC 022 is reported in lieu of TRC 011. 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 guidance. Change the beneficiary’s claim number in the Plan’s records. Any future submitted transactions for this beneficiary must use the new claim number. A transaction (Transaction Types 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81) has been successfully processed. The effective date of the transaction is reported in TRR data record field 18. Additionally, the beneficiary’s name has changed. The new name is reported in TRR data file fields 2, 3 and 4. For enrollment acceptance (Transaction Type 61), TRC 023 is reported in lieu of TRC 011. 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. Change the beneficiary’s name in the Plan’s records. To ensure accurate identification of the beneficiary, future submitted transactions for this beneficiary should use the new name. December 28, 2012 I-8 Transaction Reply Codes (TRCs)
Page 1 and 2:
Medicare Advantage and Prescription
Page 3 and 4:
Plan Communications User Guide Appe
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
F.10.3 Trailer Record Plan Communic
Page 79 and 80:
F.11.2 Record Type 2 Plan Communica
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
F.21.2 Detail Record (Transaction)
Page 137 and 138:
Page 139 and 140:
Page 141 and 142: Plan Communications User Guide Appe
Page 151 and 152: F.23.2 Detail Record (Transaction)
Page 169 and 170: Item # Plan Communications User Gui
Page 171 and 172: F.28.3 Trailer Record Plan Communic
Page 191: Plan Communications User Guide Appe
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
I.3 Obsolete Transaction Reply Code
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
CMS Transmittals to the Plans Plan
Page 343 and 344:
Page 345 and 346:
ID# Transmittal Monthly Transmittal
Page 347 and 348:
ID# Transmittal Monthly Transmittal
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
show all

Medicare Advantage and Prescription Drug Plans December 28 ...

Create successful ePaper yourself

Delete template?

Save as template?