Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
089 M Date of Birth
Change
090 M Date of Death
Established
NEW BIRTH
DATE
MEMB
DECEASED
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’s date of birth has changed. The new date of birth is reported in TRR data file field
6 (DOB) and field 24. Field 18 (Effective Date) reports the date the DOB change was processed by
CMS.
Plan Action: Update the Plan’s records. To ensure accurate identification of the beneficiary, future
submitted transactions for this beneficiary should use the new date of birth.
This TRC is not a reply to a submitted transaction but is intended to supply the Plan with additional
information about the beneficiary.
When CMS is notified of a beneficiary’s death, the Plan receives three replies in their TRR.
Transaction Type 01 with TRC 090 - only received by the Plan in which the beneficiary is
enrolled during the CPM.
Transaction Type 51 with TRC 090
Transaction Type 51 with TRC 018 or TRC 015
Transaction replies with other TRCs may also accompany these three replies. Examples
include status terminations and SSA responses.
On a Transaction Type 01 transaction with TRC 090, the beneficiary’s actual date of death is
reported in TRR data file fields 18 and 24.
On a Transaction Type 51 transaction with TRC 090, fields 18 and 24 report the effective date of the
disenrollment that results from the death. This will always be the 1 st of the month following the
death if the beneficiary is actively enrolled in a plan. If the Plan’s enrollment is not yet effective,
these fields will report the effective date of the enrollment being cancelled.
Plan Action: Update the Plan’s records with the beneficiary’s date of death from the Transaction
Type 01 transaction. It is the Transaction Type 51 transaction with TRC 018 or 015 that should be
processed as the auto-disenrollment or cancellation. Take the appropriate actions as per CMS
enrollment guidance.
Note: The above three transaction replies may not appear in the same weekly TRR
December 28, 2012 I-21 Transaction Reply Codes (TRCs)