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 284 R Cancellation Rjctd, Prior Enroll/Disenr oll Changed 285 I Enrollment Cancellation Accepted 286 R Enrollment Cancellation Rejected 287 A Enrollment Reinstated NO REINSTATE ACPT ENROLL CAN RJCT ENROLL CAN ENROLL REINSTAT A Disenrollment Cancellation (Transaction Type 81) was rejected. The cancellation action attempted the reinstatement of the enrollment and this reinstatement could not be accomplished. The reinstatement could not be accomplished because some aspect of the enrollment, or the beneficiary’s status during that enrollment, has been changed by the Plan (examples include: 4Rx, Residence Address or Segment ID) prior to their issuance of this current cancellation transaction. Plan Action: Enroll the beneficiary using a Transaction Type 61, Enrollment. An Enrollment Cancellation (Transaction Type 80) transaction was accepted. The identified enrollment is cancelled. The start date of the cancelled enrollment period is reported in the TRR data record Effective Date field, field 18. Plan Action: Update the Plan’s records accordingly. An Enrollment Cancellation (Transaction Type 80) transaction was rejected. Rejection occurred for one of the following reasons: The cancellation was submitted more than one month after the enrollment became active, the transaction attempts to cancel a Rollover, Auto or Facilitated Enrollment, or when the transaction attempts to cancel a closed enrollment period. Plan Action: Submit a Disenrollment transaction. The identified enrollment period was reinstated. The start date of the reinstated period is reported in the TRR data record Effective Date field, field 18. The reinstatement occurred for one of the following reasons: For Transaction Type 80, cancellation of another plan’s enrollment; For Transaction Type 01, change or removal of a date of death. If the reinstated enrollment has an end date, it is reported in the TRR data record field 24. The end date may or may not have existed with the enrollment originally. Plan Action: Update the Plan’s records accordingly following CMS guidance for enrollment reinstatement. December 28, 2012 I-65 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 288 A Disenrollmen t Cancellation Accepted 289 R Disenrollmen t Cancellation Rejected 290 I IEP NUNCMO Reset ACPT DISNRL CAN RJCT DISNRL CAN NUNCMO RSET IEP A Disenrollment Cancellation (Transaction Type 81) transaction was accepted. The identified disenrollment was cancelled. The start date of the cancelled disenrollment period is reported in the TRR data record Effective Date field, field 18. The Disenrollment Cancellation (Transaction Type 81) may have been submitted by a Plan or the result of a Date of Death Change or Date of Death Rescinded notification that cancels an autodisenrollment that was created by a Date of Death notification. Plan Action: Update the Plan’s records accordingly. A Disenrollment Cancellation (Transaction Type 81) transaction was rejected. Rejection occurred for one of the following reasons: Beneficiary was still enrolled in plan, never disenrolled; Beneficiary was not enrolled in the plan; Disenrollment being cancelled was not submitted by the Plan Cannot restore prior enrollment due to associated disenrollment reason codes 5, 6, 8, 9, 10, 13, 15, 18, 19, 54, 56, 57, 61 Reinstated enrollment would conflict with another existing enrollment. Plan Action: Submit Enrollment transaction. This TRC was the result of an automatic system reset, or zeroing, of the cumulative uncovered months for the identified beneficiary. This reset occurred for one of the following reasons: Disabled beneficiary became age-qualified for Medicare, An aged beneficiary had a retroactive NUNCMO transaction with an effective date prior to aged qualification at the beginning of the IEP period. Reset effective date is in TRR data record, field 18. Plan Action: Update plan records accordingly. December 28, 2012 I-66 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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