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 291 I Enrollment Reinstated, Disenrollmen t Cancellation 292 R Disenrollmen t Rejected, Was Cancellation Attempt 293 A Disenroll, Failure to Pay Part D IRMAA 294 I No 4Rx Insurance Changed 295 M Low Income NUNCMO RESET ENROLL REINSTAT NOT CANCELLATN FAIL PAY PTD IRMAA NO INSUR CHANGE NUNCMO RSET LIS A Disenrollment Cancellation (Transaction Type 81) transaction cancelled a disenrollment and the enrollment was reinstated. The start date of the reinstated period is reported in the TRR data record Effective Date field, field 18. 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. A Disenrollment transaction (Transaction Type 51) was rejected. The submitted disenrollment effective date is the same as the enrollment start date. Only Auto or Facilitated enrollments may be cancelled using the Transaction Type 51. Plan Action: Submit an Enrollment Cancellation transaction (Transaction Type 80) if it is desired to cancel the enrollment; otherwise, correct the disenrollment effective date and resubmit. A disenrollment transaction (Transaction Type 51) has been successfully processed due to failure to pay Part D IRMAA. The last day of the enrollment is reported in TRR data record fields 18 and 24. The disenrollment date is always the last day of the month. Plan Action: Ensure the Plan’s system matches the information included in the TRR record and that the beneficiary’s disenrollment date matches the date in field 24. Take the appropriate actions as per CMS enrollment guidance. A 4Rx Change (Transaction Type 72) transaction was received with no primary or secondary insurance information provided on the transaction. No insurance data changes took place for this beneficiary. Plan Action: Resubmit with new 4Rx data as needed. This TRC was the result of an automatic system reset, or zeroing, of the cumulative uncovered months for the identified beneficiary. This reset occurred because the beneficiary has been identified as having the Part D low-income subsidy. Reset effective date is in TRR data record, field 18. Plan Action: Update plan records accordingly. December 28, 2012 I-67 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 299 M Correction to Previously Failed Payment 300 R NUNCMO Change Rejected, Exceeds Max Possible Value 301 M Merged Beneficiary, Claim Number Change RESTORED PYMT NM CHG EXDS MAX BENE HICN MERGE This TRC was generated to indicate that a previously incomplete payment calculation has been completed. Plan Action: None required. A NUNCMO Record Update transaction (73) was rejected because the NUNCMO provided exceeds the maximum possible value. The original (existing) number of uncovered months has been retained. Plan Action: Review the number of uncovered months and/or the effective date submitted. If the number of uncovered months and/or the effective date should be another value, review CMS enrollment guidance and correct the NUNCMO value using a new NUNCMO Record Update (73) transaction. 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. This beneficiary had multiple conflicting claim numbers (HICNs) which were merged under a single HICN. This TRR reports the VALID HICN in field 1 and the INVALID HICN in field 24. 302 M Enrollment Cancelled, Claim Number Change ENRL CNCL MERGE Plan Action: Update the Plan’s records to use the VALID HICN from field 1 for this beneficiary. The valid claim number must be used on all future transactions for this beneficiary. 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. This beneficiary had multiple conflicting HICNs, which were merged into one. Plan enrollments for the conflicting HICNs have been combined under a valid HICN. This enrollment conflicted with another existing enrollment. As a result, the conflicting enrollment period was cancelled. The effective date of the enrollment which has been cancelled is reported in the Effective Date field (18). The termination date of the enrollment (if present) is reported in field 24. Plan Action: Because the enrollment period is now cancelled, the enrollment period should be adjusted in the Plan’s enrollment records. This change may impact premiums that you collected directly from the beneficiary. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-68 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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