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 121 M Low Income Period Status LIS UPDATE This TRC is returned on a reply with Transaction Types 01, 51, 61, 80, and 81. It is not a reply to a submitted transaction but is intended to supply the Plan with additional information about the beneficiary. It is created in response to an enrollment transaction or change in a beneficiary’s low income profile. Each TRC 121 returns start and end dates if the beneficiary is Deemed (start date only if the beneficiary is an SSA Applicant), premium subsidy percentage, and copayment category for one low income period affecting a PBP enrollment. There may be more than one TRC 121 returned. TRC 121 is issued for all periods of low income benefits that fall within the Plan’s enrollment period. The enrollment period description is identified in Field 66 with a ‘C’ for current enrollees, ‘P’ for prospective enrollees, and ‘Y’ for previous enrollees. The beneficiary’s Low-Income Subsidy source will be identified in Field 65 with an ‘A’ for Approved SSA Applicants or a ‘D’ for Deemed beneficiary by CMS. The following LIS information is displayed on the Transaction Reply Report (TRR) for TRC 121: PBP Enrollment Effective Date (Field 18) Part D Low-income Premium Subsidy Level (Field 49) Low-income Co-Pay Category (Field 50) Low-income Period start date (Field 51) Low-income Period End Date (Field 64) Low-income Period Subsidy Source (Field 65) Enrollment Period Description (Field 66) Low income subsidy TRC 223 may accompany TRC 121. These three TRCs convey the beneficiary’s low income subsidy profile affecting the identified PBP enrollment period. Plan Action: Update the Plan’s records to reflect the given data for the beneficiary’s LIS period. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-31 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 122 R Enrollment/C hange Rejected, Invalid Premium Amount 123 R Enrollment/C hange Rejected, Invalid Prm Pay Opt Cd BAD PREMIUM AMT BAD W/HOLD OPT An enrollment or premium change transaction (Transaction Type 61, or 78) was rejected because the submitted Part C premium amount was non-blank and not numeric. If the Part C premium field is blank on a submitted enrollment transaction (Transaction Type 61), the blank will be converted to zeros. Any submitted value must be numeric. A blank or invalid Part C premium field is not permitted on the Part C premium change transaction (Transaction Type 78). Plan Action: Correct the Part C premium amounts and resubmit if appropriate. An Enrollment or PPO Change transaction (Transaction Types 61, 75) was rejected because the value submitted in the PPO Code field was an invalid value. The valid values include: D - Direct Bill - Self Pay R - Deduct from RRB benefits S - Deduct from SSA benefits N - No premium applicable O (Deduct from OPM benefits) is not currently available. It is scheduled for future implementation. Plan Action: Correct the PPO code and resubmit if appropriate. December 28, 2012 I-32 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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