Medicare Advantage and Prescription Drug Plans December 28 ...

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)