Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
213 I Premium
Withhold
Exceeds
Safety Net
Amount
215 R Uncovered
Months Chng
Rejected,
Incorrect Eff
Date
216 I Uncovered
months
exceeds max
possible
value
217 R Cant Change
number of
uncovered
months
EXCEED SNET
AMT
BAD NUNCMO
EFF
NUNCMO EXDS
MAX
CANT CHG
NUNCMO
CMS has changed the PPO specified on the transaction to “D – Direct Bill” because the transaction
would result in SSA withholding exceeding the Safety Net amount from the beneficiary’s check in
one month.
This TRC may be generated in response to an accepted enrollment or PBP change (Transaction
Type 61), NUNCMO Record Update (Transaction Type 73), Part C Premium Update (Transaction
Type 78), PPO Change (Transaction Type 75), or may be initiated by CMS.
Plan Action: Change the beneficiary to Direct Bill and contact them to explain the consequences of
the PPO change. Take the appropriate actions as per CMS enrollment guidance.
A NUNCMO Change (Transaction Type 73) transaction was rejected because the submitted
effective date is incorrect. The date may have been incorrect for one of the following reasons:
The submitted effective date is prior to August 1, 2006;
The submitted effective date is after the Current Calendar Month (CCM) plus 3; or
The submitted effective date falls within a Part D plan enrollment but does not match the
contract enrollment start date.
Plan Action: Correct the effective date and resubmit the transaction if appropriate. If the Plan is
trying to correct the uncovered months value for a beneficiary who is no longer enrolled in the Plan,
contact their CMS Representative.
The NUNCMO provided on an accepted enrollment transaction (Transaction Type 61) exceeds the
maximum possible value.
This will NOT cause the rejection of the enrollment transaction but zero uncovered months (000) is
associated with the effective date of the enrollment.
This informational TRC is generated in addition to the transaction’s acceptance TRC.
Plan Action: Update the Plan’s beneficiary records to reflect the zero uncovered months. If the
NUNCMO should be another value, review CMS enrollment guidance and correct the NUNCMO
value using a new NUNCMO Record Update (Transaction Type 73) transaction.
An uncovered months change transaction (Transaction Type 73) was rejected because the submitted
transaction attempted to change the number of uncovered months for an effective date
corresponding to a “LEP Reset” transaction in the CMS database.
Plan Action: Review CMS enrollment guidance. If appropriate, submit a Number of Uncovered
Months Record Update transaction (Transaction Type 73) to UNDO the LEP Reset.
December 28, 2012 I-54 Transaction Reply Codes (TRCs)