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 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)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 091 M Date Of Death Removed 092 M Date of Death Corrected 097 R Medicaid Previously Turned On DEATH DATE OFF NEW DEATH DATE MCAID PREV ON 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. Although the Plan has previously received a transaction reply reporting a date of death for this beneficiary, the date of death has been removed. The beneficiary is still alive. TRR data file fields 18 and 24 contain the date of death that was previously reported to the Plan. If the date of death is removed after the auto disenrollment has taken effect, the Plan will not receive this transaction reply. The removal of the Date of Death may initiate the reinstatement of an enrollment. (See TRC 287) Plan Action: Update the Plan’s records and restore the beneficiary’s enrollment with the original enrollment start and end dates. 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. The date of death for this beneficiary has been corrected. The corrected date of death is reported in TRR data file field 24. The correction of the DOD may initiate the reinstatement of an enrollment. (See TRC 287) Plan Action: Update the Plan’s records. Take the appropriate actions as per CMS enrollment guidance. A correction transaction (Transaction Type 01) was rejected because this transaction attempted to set the Medicaid status for the beneficiary to ON. The Medicaid status for the beneficiary was already ON for the month in question. Note: This TRC is only applicable for submitted correction transactions (01) with effective dates prior to 1/1/2008. Plan Action: None required. Verify the Plan records. December 28, 2012 I-22 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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