Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
137 M Beneficiary
Has Received
a Kidney
Transplant
138 M Beneficiary
Address
Change to
Outside the
U.S.
139 A EGHP Flag
Change
Accepted
TRANSPLANT
ADD
ADDR NOT U.S.
EGHP FLAG CHG
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 received a transplanted kidney. 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’s address is now outside of the U.S. The effective date
of the change is reported in TRR data record field 18.
Plan Action: Research the beneficiary’s new address and update the Plan’s beneficiary records.
Take the appropriate actions as per CMS enrollment guidance.
An EGHP Update transaction (Transaction Type 74) was accepted. This transaction changed the
beneficiary’s EGHP flag.
The EGHP Update transaction may have been submitted by the Plan or initiated by a CMS User.
The value in TRR data record field 48 on the TRR record will contain the new EGHP flag. The
effective date of the change is reported in field 18 of the TRR record and in the EFF DATE column
on the printed report.
All data provided for change other than the EGHP Flag fields has been ignored.
Plan Action: Ensure the Plan’s system matches the information included in the TRR record. Take
the appropriate actions as per CMS enrollment guidance.
December 28, 2012 I-37 Transaction Reply Codes (TRCs)