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 051 R Disenrollmen t Rejected, Incorrect Effective Date 052 R Disenrollmen t Rejected, Duplicate Transaction 054 R Disenrollmen t Rejected, Retroactive Effective Date BAD DISENR DATE DUPLICATE RETRO DISN DATE A disenrollment transaction (Transaction Type 51) or a disenrollment cancellation transaction (Transaction Type 81) was rejected because the submitted enrollment effective date was either: Not the first day of the month, or More than three months beyond the Current Calendar Month (CCM+3) Note: Transactions with effective dates prior to CCM are returned with TRC 054. Plan Action: Correct the Effective Date and resubmit if appropriate. If this is a retroactive transaction, contact CMS for instructions on submitting retroactive transactions A disenrollment transaction (Transaction Type 51), enrollment cancellation transaction (Transaction Type 80), or disenrollment cancellation transaction (Transaction Type 81) was rejected because it was a duplicate transaction. CMS has already processed another a similar transaction submitted for the same contract with the same effective date. The effective date of the disenrollment is reported in the Effective Date field (18) on the TRR data file. Plan Action: None required A disenrollment transaction (Transaction Type 51 or 54) was rejected because the submitted effective date was prior to the earliest allowed date for disenrollment transactions. Effective dates for disenrollment transactions (Transaction Type 51) can be no earlier than one month prior to the Current Calendar Month (CCM) or two months prior for Transaction Type 54 transactions. The requested disenrollment effective date is reported in the Effective Date field (18) on the TRR data file. Plan Action: Correct the Effective Date and resubmit if appropriate. If this is a retroactive transaction, contact CMS for instructions on submitting retroactive transactions. December 28, 2012 I-13 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 055 M ESRD Cancellation 056 R Demonstratio n Enrollment Rejected ESRD CANCELED FAILS DEMO REQ This TRC is returned on a reply with Transaction Type 01. It is not a reply to a submitted transaction but is intended to supply the Plan with additional information about the beneficiary. This beneficiary was previously in End State Renal Disease (ESRD) status. That status has been cancelled. The effective date of the ESRD status cancellation is reported in TRR data file field 18 and 24. Plan Action: Update the Plan records. An enrollment transaction (Transaction Type 61) was rejected because the beneficiary did not meet the Demonstration requirements. For example, the beneficiary is currently known to be Working Aged or not known to be ESRD. These requirements are Plan specific. The attempted enrollment effective date is reported in TRR data file fields 18 and 24. 060 R Transaction Rejected, Not Enrolled Plan Action: Take the appropriate actions as per CMS enrollment guidance. NOT ENROLLED A Correction (Transaction Type 01), Cancellation of Enrollment (Transaction Type 80), Cancellation of Disenrollment (Transaction Type 81), or change transaction (Transaction Types 74, 75, 76, 77, 78, 79) was rejected because the beneficiary was not enrolled in a Plan as of the submitted effective date. 062 R Correction Rejected, Overlaps Other Period INS-NHC OVERLAP For NUNCMO Change transactions, Transaction Type 73, either the beneficiary is not enrolled in the plan submitting this transaction as of the month of the submission, or, the submitted effective date does not fall within a Part D plan enrollment. Plan Action: Verify the beneficiary identifying information and resubmit the transaction with updated information, if appropriate. A correction transaction (Transaction Type 01) was rejected because this transaction would have resulted in overlapping Institutional and Nursing Home Certifiable (NHC) periods. The beneficiary is not allowed to be in both Institutional and NHC status. These two types of periods are mutually exclusive. Note: This TRC is only applicable for effective dates prior to 1/1/2008. Plan Action: Ensure that the Plan’s records reflect the correct dates. December 28, 2012 I-14 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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