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 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)
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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