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 600 R UI Transaction Override UI OVERRIDE This TRC is used for special Enrollment Reconciliation TRRs. A discrepancy enrollment transaction (Transaction Type 61) was rejected because it attempted to change an existing enrollment record that was previously entered by a CMS User through the User Interface. 601 R Casework Beneficiary 602 R No Discrepancy CASEWORK BENE NO DISCREPANCY Plan Action: Update plan records accordingly and take the appropriate actions as per CMS enrollment guidance (send “Enrollment Status Update” notice to the beneficiary). This TRC is used for special Enrollment Reconciliation TRRs. A discrepancy enrollment transaction (Transaction Type 61) was rejected because the beneficiary’s enrollment was updated by CMS casework. Plan Action: Update plan records accordingly and take the appropriate actions as per CMS enrollment guidance (send “Enrollment Status Update” notice to the beneficiary). This TRC is used for special Enrollment Reconciliation TRRs. A discrepancy enrollment transaction (Transaction Type 61) was rejected because the enrollment effective date and contract/PBP in the submitted transaction matches the existing enrollment on file. There is no update to the beneficiary’s enrollment period. 603 R 2007 Date is Not Valid Plan Action: None required 2007 DT INVALID This TRC is used for special Enrollment Reconciliation TRRs. A discrepancy enrollment transaction (Transaction Type 61) was rejected because 2007 effective dates were not considered for the 2006 enrollment reconciliation. This rejection could have been caused by one of the following reasons: A 2007 enrollment or PBP was submitted and rejected because there was not a 2006 discrepancy submitted along with the 2007 enrollment. A 2006 enrollment transaction AND a 2007 PBP change record attempted to process as a Rollover. The transaction rejected because the enrollment record and the PBP change record did not have the same application signature date. Plan Action: Update plan records accordingly. If the Plan has a 2007 enrollment to correct, contact the DMS DPO representative to process a retroactive enrollment transaction. December 28, 2012 I-73 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 604 A Disenrollmen t 605 R Recon Transaction Denied DISENROLLMEN T TRANS DENIED This TRC is used for special Enrollment Reconciliation TRRs. Check dates code puts in TRR fields 18 and 24(maybe) and update text. As a result of the Enrollment Reconciliation process, this beneficiary was disenrolled due to enrollment in another Plan. Plan Action: Update plan records accordingly and take the appropriate actions as per CMS enrollment guidance (send “Enrollment Status Update” notice to the beneficiary). This TRC is used for special Enrollment Reconciliation TRRs. A discrepancy enrollment transaction (Transaction Type 61) was denied following reconciliation processing. Plan Action: Update plan records accordingly and take the appropriate actions as per CMS enrollment guidance (send “Enrollment Status Update” notice to the beneficiary). 606 I Direct Bill DIRECT BILL This TRC is used for special Enrollment Reconciliation TRRs. This beneficiary has been changed to “Direct Bill” for this enrollment period. Even though a PPO other than D was specified in the transaction, Direct Bill is the only valid option for reconciliation transactions. This transaction response will accompany the acceptance TRC for the submitted discrepancy transaction. 607 A Enrollment Accepted as Submitted ENROLL OK Plan Action: Update the Plan’s records accordingly, ensuring that the beneficiary is in direct bill status for the enrollment period. Take the appropriate actions as per CMS enrollment guidance. This TRC is used for special Enrollment Reconciliation TRRs. The submitted discrepancy enrollment transaction (Transaction Type 61) was accepted. The effective date of the enrollment period is reported in TRR data record field 18. Plan Action: Ensure that the Plan records correctly represent this enrollment. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-74 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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