Medicare Advantage and Prescription Drug Plans December 28 ...

More documents

Recommendations

Info

Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 218 M LEP Reset Undone 219 M LEP Reset Accepted 220 R Transaction Rejected; Invalid POS Enroll Source CD 222 I Bene Excluded from Transmission to SSA/RRB LEP RESET UNDNE LEP RESET BAD POS SOURCE BENE EXCLUSION CMS has reestablished the beneficiary’s late enrollment penalty (LEP). The previous LEP RESET was removed. Plan Action: Update the Plan’s records accordingly, ensuring that the beneficiary’s LEP information matches the data included in the TRR record. Take the appropriate actions as per CMS enrollment guidance. CMS has reset the beneficiary’s number of uncovered months to zero. The Late Enrollment Penalty (LEP) amount is now zero. Plan Action: Update the Plan’s records accordingly, ensuring that the beneficiary’s LEP information matches the data included in the TRR record. Take the appropriate actions as per CMS enrollment guidance. Enrollment source code submitted by a POS/POS 10 contractor for a POS/POS 10 enrollment transaction was other than ‘G’. Transaction rejected. Plan Action: Correct the Enrollment Source Code and resubmit transaction if appropriate. This TRC can be returned on a reply with various Transaction Types (51, 61, 73, 78) and the maintenance Transaction Type (01). It is intended to supply the Plan with additional information about the beneficiary. CMS has excluded beneficiary from transmission to SSA/RRB. Plan Action: None required. December 28, 2012 I-55 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 223 M Low Income Period Removed from Enrollment Period LIS REMOVED 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. It is returned for each low income subsidy period removed and not replaced over the course of a PBP enrollment. The enrollment period description is identified in Field 66 with a ‘C’ for current enrollees, ‘P’ for prospective enrollees, and ‘Y’ for previous enrollees. The beneficiary’s Low-Income Subsidy source will be identified in Field 65 with an ‘A’ for Approved SSA Applicants or a ‘D’ for Deemed beneficiary by CMS. The following LIS information is displayed on the Transaction Reply Report (TRR) for TRC 223: PBP Enrollment Effective Date (Field 18) Part D Low-income Premium Subsidy Level (Field 49) Low-income Co-Pay Category (Field 50) Low-income Period start date (Field 51) Low-income Period End Date (Field 64) Low-income Period Subsidy Source (Field 65) Enrollment Period Description (Field 66) Low income subsidy TRC 121 may accompany TRC 223. These three TRCs convey the beneficiary’s low income subsidy profile at the time of report generation. They provide a full replacement set of low income subsidy data affecting the PBP enrollment period. Plan Action: Update the Plan’s records to reflect the given data for the beneficiary’s LIS period. Take the appropriate actions as per CMS enrollment guidance. 224 A A/D MSP Beneficiary Transaction Accepted MSP ACCEPTED Aged/Disabled MSP Beneficiary transaction (85) accepted. Plan Action: None Required. December 28, 2012 I-56 Transaction Reply Codes (TRCs)
Page 1 and 2:
Medicare Advantage and Prescription
Page 3 and 4:
Plan Communications User Guide Appe
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
F.10.3 Trailer Record Plan Communic
Page 79 and 80:
F.11.2 Record Type 2 Plan Communica
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
F.21.2 Detail Record (Transaction)
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
F.23.2 Detail Record (Transaction)
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Item # Plan Communications User Gui
Page 171 and 172:
F.28.3 Trailer Record Plan Communic
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190: Plan Communications User Guide Appe
Page 239: Plan Communications User Guide Appe
Page 269 and 270: I.3 Obsolete Transaction Reply Code
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
CMS Transmittals to the Plans Plan
Page 343 and 344:
Page 345 and 346:
ID# Transmittal Monthly Transmittal
Page 347 and 348:
ID# Transmittal Monthly Transmittal
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
show all

Medicare Advantage and Prescription Drug Plans December 28 ...

Create successful ePaper yourself

Delete template?

Save as template?