Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
025 A Disenrollmen
t Accepted,
Claim
Number
Change
026 A Disenrollmen
t Accepted,
Name
Change
032 R Transaction
Rejected,
Beneficiary
Not Entitl
Part B
DISROL-NEW
HICN
DISROL-NEW
NAME
MEMB HAS NO B
A disenrollment transaction (Transaction Type 51) submitted by the Plan has been successfully
processed. The effective date of the disenrollment is reported in TRR data file field 18. The
disenrollment date will always be the last day of the month.
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.
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. Change the beneficiary’s claim number in
the Plan’s records. Future submitted transactions for this beneficiary must use the new claim
number.
A disenrollment transaction (Transaction Type 51) submitted by the Plan has been successfully
processed. The effective date of the disenrollment is reported in the TRR data record field 18. The
disenrollment date will always be the last day of the month.
Additionally, The beneficiary’s name has changed. The new name is reported in TRR data file
fields 2, 3 and 4 and in the corresponding columns in the printed report.
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. 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.
This TRC is returned for an enrollment or PBP change transaction (Transaction Type 61) or a
disenrollment cancellation transaction (Transaction Type 81) [enrollment reinstatement] . Part B
entitlement is required for enrollment in a MCO. (MA, MAPD, HCPP, Cost 1, Cost 2 or Demos).
TC61 – transaction was rejected because the submitted enrollment date is outside the
beneficiary’s Part B entitlement period
TC81 – transaction was rejected because the enrollment reinstatement period is outside the
beneficiary’s Part B entitlement period
Plan Action: Take the appropriate actions as per CMS enrollment guidance.
December 28, 2012 I-9 Transaction Reply Codes (TRCs)