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 182 I Invalid PTC Premium Submitted, Corrected 184 R Enrollment Rejected, Beneficiary is in Medicaid PTC PRM OVERIDE MBR IN MEDICAID The Part C premium submitted on the enrollment, PBP change, Enrollment Cancellation, Disenrollment Cancellation or Part C Premium Record Update transaction (Transaction Types 61, 78, 80, 81) does not agree with the Plan’s defined Part C premium rate. The premium has been adjusted to reflect the defined rate. The correct Part C premium rate is reported in TRR data record field 24. If the submitted Part C premium is less than the Basic Part C premium for the plan, MARx will reset the premium to the Part C Basic plus Mandatory Supplemental Premium Rate, Net of Rebate from the HPMS file. This TRC provides additional information about an enrollment, PBP change, Enrollment Cancellation, Disenrollment Cancellation or Part C Premium Record Update transaction (Transaction Types 61, 78, 80, 81) 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 beneficiary records with the premium information in the TRR record. Take the appropriate actions as per CMS enrollment guidance. An enrollment transaction (Transaction Type 61) was rejected because the beneficiary was in Medicaid status and the Plan is not eligible to enroll Medicaid beneficiaries. This TRC is Plan specific. It only applies to MSA/MA and MSA/Demo plans. Plan Action: Update the Plan’s beneficiary records to reflect the fact that the beneficiary is not enrolled in the Plan. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-45 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 185 M Withholding Agency Accepted Transaction ACCEPTED CMS submitted information on a beneficiary to SSA/RRB (See TRC 120). TRC 185 is sent to the Plan when SSA/RRB acknowledges that they have accepted and processed the beneficiary data. If the submittal to SSA/RRB was the result of a requested premium withholding change, TRC 185 informs the Plan that SSA/RRB has accepted and processed the change. The beneficiary’s PPO is reported in DTRR field 39. The effective date of the PPO change is reported in field 18. Note: The reported new PPO may be the same as the existing PPO. Plans will not see the results of any requested premium withholding changes until TRC 185 is received. 186 I Withholding Agency Rejected Transaction REJECTED Plan Action: Ensure the Plan’s system matches the information, primarily the PPO, included in the DTRR. CMS submitted information on a beneficiary to SSA/RRB (See TRC 120). This data transmittal was rejected by SSA/RRB. This is exclusive to the communication between CMS and SSA/RRB. CMS will continue to interface with SSA/RRB to resolve the rejection. If CMS is unable to resolve this rejection and the Beneficiary-requested PPO is changed, the Plan may receive a TRC 144. 187 R No Change in Number of Uncovered Mths Information DUP NO UNCV MTH Plan Action: No action required. A Number of Uncovered Months Record Change transaction (Transaction Type 73) was rejected. No data change was made to the beneficiary’s record. The submitted transaction contained Number of Uncovered Months Information that matched those already on record with CMS. This transaction had no effect on the beneficiary’s records. Plan Action: None required. December 28, 2012 I-46 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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