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 242 I No Change in Primary Drug Information DUP PRIMARY RX A 4Rx Record Update transaction (72) was submitted, however, no data change was made to the beneficiary’s record. The submitted transaction contained Primary Drug Insurance Information (Primary Rx ID, Primary Rx Group, Primary Rx BIN, Primary Rx PCN) that matched the Primary Drug Insurance values already on record with CMS. This transaction had no effect on the beneficiary’s records. 243 R Change to SSA Withholding rejected due to no SSN NO SSN AT CMS Plan Action: None required. A PPO Change transaction (Transaction Type 75) was submitted to change the beneficiary’s PPO to SSA withholding, however, there is no Social Security Number (SSN) on file at CMS. The beneficiary’s PPO is not changed to SSA withholding. The beneficiary’s records were unchanged. 245 M Member has MSP period 252 I Prem Payment Option Changed to Direct Bill; No SSN 253 M Changed to Direct Bill; no Funds Withheld MEMBER IS MSP W/O CHG;NO SSN W/O CHG;NO W/H Plan Action: Update the Plan’s beneficiary record accordingly. Take the appropriate action with member as per CMS enrollment guidance. The beneficiary has other insurance and Medicare is secondary payer. All plans whose payments are impacted by the MSP notification will receive the TRC. Plan Action: Update the Plan’s records accordingly. CMS has changed the PPO specified on the transaction to “D – Direct Bill” because the beneficiary does not have a Social Security number on file at CMS. This TRC may be generated in response to an accepted Enrollment, PBP change or PPO Change transaction (Transaction Types 61 or, 75) or may be initiated by CMS. Plan Action: Update the Plan’s beneficiary records to reflect the direct bill payment method. Take the appropriate actions with member as per CMS enrollment guidance. CMS has changed the PPO to “D-Direct Bill” because no funds have been withheld by the withholding agency in the two months since withholding was accepted. Plan Action: Update the Plan’s beneficiary records to reflect the direct bill payment method. Take the appropriate actions with member as per CMS enrollment guidance. December 28, 2012 I-59 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 254 I Beneficiary set to Direct Bill, spans jurisdiction DIR BIL JRSDCTN CMS has changed the PPO to “D-Direct Bill” because the withholding request spans two different withholding agency jurisdictional periods. This could occur for one of the following reasons: SSA is the beneficiary’s current withholding agency but the withholding request contains one or more periods from when RRB was the beneficiary’s withholding agency. RRB is the beneficiary’s current withholding agency but the withholding request contains one or more periods from when SSA was the beneficiary’s withholding agency. 255 I Plan Submitted RRB W/H for SSA Beneficiary 256 I Plan Submitted SSA W/H for RRB Beneficiary 257 F Failed; Birth Date Invalid for Database Insertion RRB WHOLD 4 SSA SSA WHOLD 4 RRB Plan Action: Update the Plan’s beneficiary records to reflect the Direct Bill payment method. Take the appropriate actions with member as per CMS enrollment guidance. CMS has changed the PPO to “S-SSA Withhold” because SSA is the correct withholding agency for this beneficiary. Plan Action: None required. CMS has changed the PPO to “R-RRB Withhold” because RRB is the correct withholding agency for this beneficiary. Plan Action: None required. INVALID DOB An Enrollment transaction (Transaction Type 61), change transaction (Transaction Types 72, 73, 74, 75, 77, 78, 79), residence address transaction (Transaction Type 76), or cancellation transaction (Transaction Types 80, 81) failed because the submitted birth date was either Not formatted as YYYYMMDD (e.g., “Aug 1940”), or Formatted correctly but contained a nonexistent month or day (e.g., “19400199”). As a result, the beneficiary could not be identified. The transaction record will not appear on the TRR (TRR) data file but will be returned on the Batch Completion Status Summary (BCSS) data file along with the failed record. Plan Action: Correct the date format and resubmit transaction. December 28, 2012 I-60 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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