Medicare Advantage and Prescription Drug Plans December 28 ...

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)