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 265 A Residence Address Change Accepted, New SCC 266 R Unable to Resolve SSA State County Codes 267 M PPO set to N due to No Premium 268 I Beneficiary Has Dialysis Period RES ADR SCC SCC UNRESOLVED PPO SET TO N DIALYSIS EXISTS A residence address change transaction (Transaction Type 76) was accepted. This beneficiary’s state and county code (SCC) information may have changed. SCC values are returned in TRR data record fields 9 (state code) and 10 (county code) and together in field 24. The residence address period start date is in field 18. Any provided end date is in field 24. This TRC is accompanied by TRC 085 if the submitted residence address has changed the beneficiary’s SCC. This TRC may be accompanied by TRC 154 if the submitted residence address has placed the beneficiary outside the plan’s service area. Plan Action: Update the Plan’s records. A residence address transaction (Transaction Type 76) was rejected because SSA state and county codes (SCC) could not be resolved. The beneficiary’s residence address was not changed. Plan Action: Confirm the address specified in the transaction. Update and resubmit the transaction if necessary; otherwise, contact your district office for assistance. The beneficiary’s PPO was set to N because their premium is $0. This occurs as part of an end-ofyear process based on the Plan’s basic Part C premium for the upcoming year. Plan action: Submit a transaction to reset the Part C premium and to renew a request for withholding status if appropriate. This TRC is returned on an enrollment. It is intended to supply the Plan with additional information about the beneficiary. Each TRC 268 returns start and end dates for each dialysis period that overlaps the enrollment period. There may be more than one TRC 268 returned. The effective date for the dialysis period is shown in the Effective Date field (field 18). The end date, if one exists, is in the Open Data field (field 24). Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-63 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 269 I Beneficiary Has Transplant TRNSPLNT EXISTS This TRC is returned on an enrollment. It is intended to supply the Plan with additional information about the beneficiary. Each TRC 269 returns transplant and failure dates for each kidney transplant that overlaps the enrollment period. There may be more than one TRC 269 returned. The transplant date is shown in the Effective Date field (field 18). The end date, if one exists, is shown in Transplant End Date (field 24). 270 M Beneficiary Transplant Has Ended 280 I Member MSP Period Ended 282 A Residence Address Deleted 283 R Residence Address Delete Rejected TRANSPLANT END MEMBER NOT MSP RES ADR DELTD RJCTD ADR DELT Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Take the appropriate actions as per CMS enrollment guidance. 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. CMS was notified that the beneficiary’s transplant s failed or was an error. The effective date of the failure or removal is reported in field 18 of the TRR record and in the EFF DATE column on the printed report. Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Take the appropriate actions as per CMS enrollment guidance. The beneficiary’s Medicare as Secondary Payer period has ended. All plans whose payments are impacted by the MSP notification will receive the TRC. Plan Action: Update the Plan’s records accordingly. The residence address associated with the TRR data record effective date (in field 18) has been deleted and is no longer valid. The address was removed either through “delete” action via the 76 transaction or because an overlapping residence address change was submitted with the same or earlier effective date. Plan Action: None required. The residence address delete attempted was rejected. No residence address exists for the effective date provided. See TRR data record, field 18. Plan Action: Correct effective date and resubmit. December 28, 2012 I-64 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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