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 608 A Enrl Accepted, CMS Established Eff and End Dates 609 A Enrollment Accepted with CMS established Eff date 610 A Enrollment Accepted with CMS Established End Date ENRLD/CMS DTS ENRLD/CMS EFF ENRLD/CMS END This TRC is used for special Enrollment Reconciliation TRRs. The submitted discrepancy enrollment transaction (Transaction Type 61) was accepted but the effective date and end date for the enrollment period were provided by CMS. The new effective date of the enrollment period is reported in TRR data record field 18. Plan Action: Update Plan records to be consistent with the dates in fields 18 and 54(?). Review ALL enrollment periods in the Full Enrollment file to determine the beneficiary’s status. Take the appropriate actions as per CMS enrollment guidance (send appropriate “Enrollment Status Update” notice). This TRC is used for special Enrollment Reconciliation TRRs. The submitted discrepancy enrollment transaction (Transaction Type 61) was accepted but the effective date for the enrollment period was provided by CMS. The effective date of the new enrollment period is reported in TRR data record field 18. Plan Action: Update Plan records to be consistent with the dates in fields 18. Review ALL enrollment periods in the Full Enrollment file to determine the beneficiary’s status. Determine if a premium refund is required. Take the appropriate actions as per CMS enrollment guidance (send appropriate “Enrollment Status Update” notice). This TRC is used for special Enrollment Reconciliation TRRs. The submitted discrepancy enrollment transaction (Transaction Type 61) was accepted but the end date for the enrollment period was provided by CMS. The submitted effective date of the enrollment period is reported in TRR data record field 18. Plan Action: Update Plan records to be consistent with the dates in fields 18. Review ALL enrollment periods in the Full Enrollment file to determine the beneficiary’s status. Determine if a premium refund is required. Take the appropriate actions as per CMS enrollment guidance (send appropriate “Enrollment Status Update” notice). December 28, 2012 I-75 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 611 R No Discrepancy in 2006 701 A New UI Enrollment (Open Ended) 702 A UI Fill-In Enrollment NO DISCREP 2006 UI ENROLLMENT UI FILL-IN ENRT This TRC is used for special Enrollment Reconciliation TRRs. A discrepancy enrollment transaction (Transaction Type 61) was rejected because the enrollment matched exactly what CMS has on file for the calendar year of the reconciliation. However, CMS has identified an enrollment discrepancy which exists in another contract or calendar year. Plan Action: Review ALL enrollment periods in the Full Enrollment file to confirm the status of the beneficiary. The Plan should work through the established retroactive process to correct discrepancies associated with a calendar year other than the year being reconciled. A CMS User or a Plan User with Update Authority enrolled this beneficiary in this contract under the indicated PBP (if applicable) and segment (if applicable). TRR data record, field 18 contains the enrollment effective date. This is an open-ended enrollment which does not have a disenrollment date. The Part C Premium amount may have been populated automatically with the base Part C premium amount. Plan Action: Update the Plan’s beneficiary records with the information in the TRR. Verify the Part C premium amount and submit a Record Update transaction if necessary. Take the appropriate actions as per CMS enrollment guidance. A CMS User or Plan User with Update Authority enrolled this beneficiary in this contract under the indicated PBP (if applicable) and segment (if applicable). This enrollment is a Fill-In Enrollment and represents a complete enrollment period that begins on the date in TRR data record field 18 and ends on the date in field 24. This is a distinct enrollment period and does not affect any existing enrollments. The Part C Premium amount may have been populated automatically with the base Part C premium amount. Plan Action: Update the Plan’s records to reflect the beneficiary’s enrollment as of the effective date in TRR data record field 18 and the ending on the date in field 24. This end date should not affect the beginning of any existent enrollment periods. Verify the Part C premium amount and submit a Record Update transaction if necessary. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-76 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription Drug Plans December 28 ...

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