Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
196 R Transaction
Rejected,
Bene not
Eligible for
Part D
197 M Part D
Eligibility
Termination
NO PART D
PART D OFF
An enrollment transaction or PBP change transaction (Transaction Type 61) or disenrollment
cancellation transaction (Transaction Type 81) [enrollment reinstatement] was rejected. Part D
eligibility is required for Part D plan enrollment.
TC61 – transaction was rejected because the submitted enrollment date is outside the
beneficiary’s Part D eligibility period
TC81 – transaction was rejected because the enrollment reinstatement period is outside the
beneficiary’s Part D eligibility period
Plan Action: Take the appropriate actions as per CMS enrollment guidance.
This TRC is returned on a reply with Transaction Type 01 and occasionally with Transaction Type
51 and Transaction Type 61. When returned with Transaction Type 01, the TRC is in response to a
change in beneficiary Part D Eligibility. It is not a reply to a submitted transaction but is intended to
supply the Plan with additional information about the beneficiary.
In the case of Transaction Type 01, this beneficiary’s Part D eligibility has been terminated. The
effective date of the termination is reported in TRR data record fields 18 and 24.
If applicable, CMS will automatically disenrolls the beneficiary from the plan. A Transaction Type
51 transaction will be sent in this or another TRR.
When this TRC is returned with Transaction Type 61 the TRC is in response to a retroactive
enrollment and is identifying the fact that an enrollment end date has been established due to the
beneficiary’s termination of Part D. The enrollment start date is in TRR data record field 18 and the
enrollment end date is in field 24. In this circumstance it is accompanied by TRC 018, Automatic
Disenrollment, as well.
Note: A TRR record with this reply code is only reported to the Plan in which the beneficiary is
currently enrolled, even if it affects periods of enrollment in other Plans.
Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Take the
appropriate actions as per CMS enrollment guidance.
December 28, 2012 I-50 Transaction Reply Codes (TRCs)