Medicare Advantage and Prescription Drug Plans December 28 ...

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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)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 033 R Transaction Rejected, Beneficiary Not Entitl Part A 034 R Enrollment Rejected, Beneficiary is Not Age 65 035 R Enrollment Rejected, Beneficiary is in Hospice 036 R Transaction Rejected, Beneficiary is Deceased MEMB HAS NO A MEMB NOT AGE 65 MEMB IN HOSPICE MEMB DECEASED 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 A entitlement is required for enrollment in a MCO (MA, MAPD, or Demos). TC61 – transaction was rejected because the submitted enrollment date is outside the beneficiary’s Part A entitlement period TC81 – transaction was rejected because the enrollment reinstatement period is outside the beneficiary’s Part A entitlement period Plan Action: Take the appropriate actions as per CMS enrollment guidance. A submitted enrollment or PBP change transaction (Transaction Type 61) was rejected because the beneficiary was not age 65 or older. The age requirement is Plan-specific. Plan Action: Take the appropriate actions as per CMS enrollment guidance. A submitted enrollment or PBP change transaction (Transaction Type 61) was rejected because the beneficiary was in Hospice status. The Hospice requirement is Plan-specific (e.g. applies only to MSA/MA, MSA/Demo, OFM Demo, ESRD I Demo, ESRD II Demo, and PACE National Plans). The attempted enrollment date is reported in TRR data record field 18 and 24. Plan Action: Update the Plan records accordingly and take the appropriate actions as per CMS enrollment guidance. A submitted enrollment or PBP change transaction (Transaction Type 61) or disenrollment cancellation transaction (Transaction Type 81) enrollment reinstatement was rejected because the beneficiary is deceased. The beneficiary DOD is reported in TRR data record fields 18 and 24. Plan Action: Update the Plan records accordingly and take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-10 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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