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 157 R Contract Not Authorized for Transaction Code 158 M Institutional Period Change/Canc ellation 159 M NHC Period Change/Canc ellation 162 R Invalid EGHP Flag Value 165 R Processing delayed due to MARx system problems UNAUT REQUEST INST CHANGE NHC CHANGE BAD EGHP FLAG SYSTEM DELAY A transaction (Transaction Types 41, 51, 54, 61, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81) was rejected because the Plan is not authorized to submit that type of transaction. Plan Action: Correct the Transaction Type and resubmit if appropriate. 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 changed or cancelled an Institutional period for the beneficiary. 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 changed or cancelled a NHC period for the beneficiary. Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Take the appropriate actions as per CMS enrollment guidance. An enrollment or EGHP change transaction (Transaction Types 61, 74) was rejected because the submitted EGHP Flag value was invalid. The valid values for EGHP Flag is Y or blank for enrollment Transaction Type 61. Y or N id accepted for EGHP change Transaction Type 74. Plan Action: Correct the EGHP Flag value and resubmit if appropriate. Processing of this transaction has been delayed due to CMS system conditions. No action is required by the user. CMS will process the transaction as soon as possible. Plan Action: Wait for further information from CMS. December 28, 2012 I-41 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 166 R Part D FBD Auto Enroll or Facilitated Enroll Reject 169 R Reinsurance Demonstratio n Enrollment Rejected 170 I Premium Withhold Option Changed to Direct Billing 171 R Record Update Rejected, Invalid Chg Effective Dt PARTD AUTO REJ EMP SUBSIDY PREM WH OPT CHG BAD CHG EFF DT A plan-submitted auto or facilitated Part D enrollment was rejected because CMS has a record of an ‘opt out’ option on file for the beneficiary. This beneficiary has “opted out” of auto or facilitated enrollment. Plan Action: Update the Plan’s records to ensure that the beneficiary is not enrolled in the Plan. Take the appropriate actions as per CMS enrollment guidance. An enrollment transaction (Transaction Type 61) placing the beneficiary into a reinsurance demonstration Plan was rejected because the beneficiary has employer subsidy periods overlapping with the requested enrollment period. This TRC is equivalent to TRC 127 except that it applies to Reinsurance Demonstration Plans only. The requested effective date is reported in TRR data file field 18. Plan Action: 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. The beneficiary’s PPO was changed to Direct Billing (D) because the beneficiary is a member of an employer group. Retirees who are members of an employer group cannot elect SSA withholding. This TRC provides additional information about an enrollment, PBP change, or PPO Change transaction (Transaction Types 61, 75) for which an acceptance was sent in a separate Transaction Reply with an enrollment acceptance TRC. The Effective Date of the enrollment for which this information is pertinent is reported in TRR data record field 18. Plan Action: Update the Plan’s billing method and contact the beneficiary to explain the consequences of this change. An EGHP Change, PPO Change, Segment ID Change, or Part C Premium Change (Transaction Types 74, 75, 77, 78) was rejected because the submitted transaction effective date was incorrect. The Effective Date on the Transaction Type 75 must be in the CPM to CPM+2 range. The Effective Date on the Transaction Types 78 must be in the CPM-3 to CPM+2 range. The Effective date on the Transaction Types 74, 76 must be in the CCM-1 to CCM+3 range. Plan Action: Correct the effective date and resubmit the transaction if appropriate. December 28, 2012 I-42 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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