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 198 M Part D Eligibility Reinstatemen t 200 R Rx BIN Blank or Not Valid 201 R Rx ID Blank or Not Valid 202 R Rx Group Not Valid PART D ON BIN BLANK/INVLD ID BLANK/INVLID RX GRP INVALID 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. This beneficiary’s Part D eligibility has been reinstated. The effective date Part D eligibility start date is reported in TRR data record fields 18 and 24. 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. If, as a result of a loss of Part D eligibility, the beneficiary has been disenrolled, but not re-enrolled, the reply code is not issued. 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 transaction or 4Rx change transaction (Transaction Types 61, 72) was rejected because the primary drug insurance Rx BIN field was either blank or did not have a valid value. Exception: Rx Bin for primary drug insurance is not a mandatory field for enrollments transactions for PACE National Part D plans. Plan Action: Correct the Primary Rx BIN value and resubmit the transaction if appropriate. An enrollment transaction or 4Rx change transaction (Transaction Types 61, 72) was rejected because the primary drug insurance Rx ID field was either blank or does not have a valid value. Exception: Rx ID for primary drug insurance is not a mandatory field for enrollments transactions for PACE National Part D plans. Plan Action: Correct the Primary Rx ID value and resubmit the transaction if appropriate. An enrollment transaction or 4Rx change transaction (Transaction Types 61, 72) was rejected because the primary drug insurance Rx GRP field does not have a valid value. Plan Action: Correct the Primary Rx GRP value and resubmit the transaction if appropriate. December 28, 2012 I-51 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 203 R Rx PCN Not Valid 204 A Record Update for Primary 4Rx Data Successful 205 I Invalid Disenrollmen t Reason Code 206 I Part C Premium has been corrected to zero RX PCN INVALID 4RX CHNG ACPTED INV DISENRL RSN PTC PREM ZEROED An enrollment or 4Rx change transaction (Transaction Types 61, 72) was rejected because the primary drug insurance Rx PCN field does not have a valid value. Plan Action: Correct the Primary Rx PCN value and resubmit the transaction if appropriate. A submitted 4Rx Record Update transaction (Transaction Type 72) included a request to change primary drug insurance 4Rx data. The 4Rx data were successfully changed. Note: At a minimum, values must be provided for both of the mandatory primary 4Rx fields, RX BIN and RX ID Plan Action: No action required. A disenrollment transaction (Transaction Type 51) was submitted with a blank or invalid disenrollment reason code. CMS substituted the default value of ‘99’ for the disenrollment reason code. See Page I-103 for CMS enrollment guidance regarding valid disenrollment reason codes. This TRC provides the Plan with additional information on a disenrollment that was processed successfully. It is received in addition to the appropriate disenrollment acceptance TRC. Plan Action: None required. An enrollment, PBP change or Part C Premium Update transaction (Transaction Types 61, 78) was submitted and accepted for a Part D only Plan. This transaction contained an amount other than zero in the Part C premium field. Since a Part C premium does not apply to a Part D only Plan, the Part C premium has been corrected to be zero. This TRC provides additional information about an enrollment, PBP change, or Part C Premium Update transaction (Transaction Types 61, 78) for which an acceptance was sent in a separate Transaction Reply with an 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 records accordingly, ensuring that the beneficiary’s information matches zero Part C premium amount included in the TRR record. December 28, 2012 I-52 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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