Medicare Advantage and Prescription Drug Plans December 28 ...

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)