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 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)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 140 A Segment ID Change Accepted 141 A Uncovered Months Change Accepted 143 A Secondary Insurance Rx Number Change Accepted SEGMENT ID CHG UNCOV MNTHS CHG 4RX SCD INS CHG A Segment ID Update transaction (Transaction Type 77) was accepted. This transaction changed the Segment ID for the beneficiary. The value in TRR data record field 33 contains the new Segment ID. The effective date of the change is reported in field 18 All data provided for change other than the Segment ID field 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. A Number of Uncovered Months Record Update transaction (Transaction Type 73) was accepted. This transaction updated the creditable coverage information (Creditable Coverage Flag and/or Number of Uncovered Months) for the beneficiary. The values in TRR data record fields 40 and 41 on the TRR record will contain the new creditable coverage values. The effective date of the change is reported in field 18. Total uncovered months are displayed in field 24. All data provided for change, other than the Uncovered Months 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. A 4Rx Record Update transaction (Transaction Type 72) was accepted. This transaction updated the secondary drug insurance information (Secondary RxID, Secondary RxBIN, Secondary Rx Group, Secondary RxPCN) for the beneficiary. The 4Rx Record Update transaction may have been submitted by the Plan or initiated by a CMS User. The values in TRR data record fields 46, 47, 60 & 61 on the TRR record will contain the new secondary drug insurance information. The effective date of the change is reported in field 18. All data provided for change, other than the 4Rx 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-38 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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