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 124 R Enrollment/C hange Rejected; Invalid Uncov Months 126 R Enrollment/C hange Rejected; Invalid Cred Cvrg Flag 127 R Part D Enrollment Rejected; Employer Subsidy Status BAD UNCOV MNTHS BAD CRED COV FL EMP SUB REJ An enrollment or number of uncovered months change transaction (Transaction Types 61, 73) was rejected because the Number of Uncovered Months field was not correctly populated. This rejection could be the result of the following conditions: The field contained a non-numeric value The Uncovered Months field was zero when the Creditable Coverage Switch was set to N For Transaction Type 61, the Uncovered Months field was greater than zero when the Creditable Coverage Switch was set to Y or blank. For Transaction Type 73, the Uncovered Months field was greater than zero when the Creditable Coverage Switch was set to Y. Plan Action: Correct the Number of Uncovered Months value and resubmit the transaction if appropriate. Verify that the Creditable Coverage Flag and Number of Uncovered Months combination is valid. An enrollment or number of uncovered months change transaction (Transaction Types 61, 73) was rejected because the Creditable Coverage Flag field was not correctly populated. For Transaction Type 61, the valid values for the Creditable Coverage Flag are Y, N, and blank. For Transaction Type 73, the valid values for the Creditable Coverage Flag are Y and N. Plan Action: Correct the Creditable Coverage Flag value and resubmit the transaction if appropriate. Verify that the Creditable Coverage Flag and Number of Uncovered Months combination is valid. An enrollment transaction (Transaction Type 61) was rejected because the beneficiary has employer subsidy periods overlapping with the requested enrollment period. The requested effective date is reported in TRR data file field 18. Plan Action: Take the appropriate actions as per CMS enrollment guidance. Contact the beneficiary to explain the potential consequences of this enrollment. If the beneficiary elects to join the Part D plan anyway, the enrollment should be resubmitted with the Employer Subsidy Override Flag set to Y. December 28, 2012 I-33 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 128 R Part D Enroll Reject; Emplyr Sbsdy set: No Prior Trn EMP SUB OVR REJ An enrollment transaction (Transaction Type 61) was rejected because the beneficiary has employer subsidy periods overlapping with the requested enrollment period. Even through this transaction was submitted with the Employer Subsidy Override Flag set to Y, the override is not valid because there is no record that the enrollment was previously submitted and rejected with TRC 127 (Part D Enrollment Rejected; Employer Subsidy Status). CMS enforces this two-step process to ensure that the Plan discusses the potential consequences of the Part D enrollment (i.e. possible loss of employer health coverage) with the beneficiary before CMS accepts the employer subsidy override. 129 I Part D Enroll Accept;Emp Sbsdy set; Prior Trn Reject EMP SUB ACC Plan Action: Take the appropriate actions as per CMS enrollment guidance. Contact the beneficiary to explain the potential consequences of this enrollment. If the beneficiary elects to join the Part D plan anyway, the enrollment should be resubmitted with the Employer Subsidy Override Flag set. This TRC provides additional information about a new enrollment (Transaction Type 61). The effective date of the enrollment for which this information is pertinent is reported in TRR data record field 18. This newly enrolled beneficiary had employer subsidy periods overlapping with the requested enrollment period. A prior enrollment transaction was rejected with TRC 127 or 128. The Plan resubmission of the enrollment transaction with the Employer Subsidy Override Flag set to Y indicates that the Plan has contacted the beneficiary to explain the potential consequences of this enrollment, and that the beneficiary elected to join the Part D Plan anyway. Plan Action: No action required. Process the accompanying transaction enrollment acceptance transaction. December 28, 2012 I-34 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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