Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
077 M Medicaid
Status Set
MEDICAID ON A reply with this TRC is seen for plan submitted retroactive Transaction Type 01 and 30
transactions and occasionally Transaction Type 61 enrollment transactions.
078 M Medicaid
Status
Terminated
MEDICAID OFF
In the case of Transaction Type 01, this beneficiary has been placed in Medicaid Status by the plan.
The effective date of the Medicaid Status is reported in the TRR in field 18. This date is always the
first of the month and is retroactive.
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 having a Medicaid 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.
Transaction type 30, when provided with the request type 22, is a rate recalculation for a Medicaid
status change.
Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment
guidance.
A reply with this TRC may be informational from CMS Transaction Type 30 or in response to a
Transaction Type 01 transaction submitted by the Plan.
This beneficiary’s Medicaid Status has been terminated. The effective date of the termination of
Medicaid Status is reported in TRR data file fields 18 and 24 of the TRR. This date is always the
last day of the month.
Transaction type 30, when provided with the request type 22, is a rate recalculation for a Medicaid
status change.
Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment
guidance.
December 28, 2012 I-17 Transaction Reply Codes (TRCs)