Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
134 I Missing
Secondary
Insurance
Information
135 M Beneficiary
Has Started
Dialysis
Treatments
136 M Beneficiary
Has Ended
Dialysis
Treatments
NO 2 INS INFO
DIALYSIS START
DIALYSIS END
An Enrollment, PBP Change, or 4Rx Record Update transaction (Transaction Types 61, 72) was
submitted with the Secondary Insurance Flag set to Y, but the associated secondary insurance fields
(Secondary RxID and Secondary RxGroup) were not populated. No changes to the beneficiary’s
secondary insurance information were made.
This is not a transaction rejection. The submitted transaction was accepted and a reply was
provided in the TRR with an appropriate acceptance TRC. This reply provides additional
information about the transaction. The Effective Date of the transaction for which this information
is pertinent is reported in TRR data record field 18. The Transaction Type will reflect the
Transaction Type of the submitted transaction. (Transaction Types 61 or 72).
Plan Action: If appropriate, submit a 4Rx Record Update transaction (Transaction Type 72) with
the correct Secondary Insurance RxID and Secondary Insurance RxGroup values.
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.
CMS has been notified that the beneficiary has ESRD and has begun dialysis treatments. The
effective date of the change is reported in TRR data file field 18.
Plan Action: Update the Plan’s beneficiary records with the information in the TRR. 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.
CMS has been notified that the beneficiary has ESRD and is no longer receiving dialysis treatments.
The effective date of the change is reported in DTRR data file field 18.
Plan Action: Update the Plan’s beneficiary records with the information in the DTRR. Process the
TRC 136 to remove the prior period , if the effective date of the TRC 136 (field 18) is equal to the
“start” date of an ESRD period reported to the Plan previously. Alternatively, process the TRC 136
to update the prior period, if the effective date of the TRC 136 (field 18) is not equal to the “start”
date of an ESRD period reported to the Plan in a prior DTRR. Then process the TRC 135 to add the
new corrected period as of the start date in field 18. The end date of the new, corrected period, if
there is one, is not included.. Take the appropriate actions as per CMS enrollment guidance.
December 28, 2012 I-36 Transaction Reply Codes (TRCs)