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 071 M Hospice Status Set 072 M Hospice Status Terminated HOSPICE ON HOSPICE OFF This TRC is returned on a reply with Transaction Type 01 and occasionally with Transaction Type 51, and Transaction Type 61. When returned with Transaction Type 01, the TRC is in response to a change in beneficiary Hospice status. It is not a reply to a submitted transaction but is intended to supply the Plan with additional information about the beneficiary. In the case of Transaction Type 01, a notification has been received that this beneficiary is in Hospice status. The date on which Hospice Status became effective is reported in TRR data file fields 18 and 24. The effective date for Hospice Status is not restricted to the first or last day of the month. It may be any day of the month. When this TRC is returned with Transaction Type 61 the TRC is in response to a retroactive enrollment and is identifying the fact that an enrollment end date has been established due to the beneficiary’s hospice status. The enrollment start date is in TRR data file field 18 and the enrollment end date is in field 24. In this circumstance it is accompanied by TRC 018, Automatic Disenrollment, as well. Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment guidance. 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. A notification has been received that this beneficiary’s Hospice Status has been terminated. The end date for the Hospice Status is reported in TRR data file fields 18 and 24. The date for termination of Hospice Status is not restricted to the first or last day of the month. It may be any day of the month. Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-15 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 073 M ESRD Status Set 074 M ESRD Status Terminated 075 A Institutional Status Set ESRD ON ESRD OFF INSTITUTION ON This TRC is returned on a reply with Transaction Type 01 and occasionally with Transaction Type 61. When returned with Transaction Type 01, the TRC is in response to a change in beneficiary ESRD status. It is not a reply to a submitted transaction but is intended to supply the Plan with additional information about the beneficiary. In the case of Transaction Type 01, a notification has been received that this beneficiary is in End Stage Renal Disease (ESRD) status. The date on which ESRD Status became effective reported in TRR data file fields 18 and 24. When this TRC is returned with Transaction Type 61 the TRC is in response to a retroactive enrollment and is identifying the fact that an enrollment end date has been established due to the beneficiary’s ESRD status. The enrollment start date is in TRR data file field 18 and the enrollment end date is in field 24. In this circumstance it is accompanied by TRC 018, Automatic Disenrollment, as well. Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment guidance. 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. A notification has been received that this beneficiary’s End Stage Renal Disease (ESRD) Status has been terminated. The end date for the ESRD Status is reported in TRR data file fields 18 and 24. Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment guidance. A correction transaction (Transaction Type 01) placed the beneficiary in Institutional status. The effective date of the Institutional status is shown in TRR data record field 24. Institutional status automatically ends each month; therefore, there is no Institutional Status termination transaction. This TRC is only applicable for application dates prior to 01/01/2008. Plan Action: Update the Plan records. Take the appropriate actions as per CMS enrollment guidance. Note: This TRC is only applicable for effective dates prior to 01/01/2008. December 28, 2012 I-16 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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