Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
703 A UI
Enrollment
Cancel
(Delete)
704 A UI
Enrollment
Cancel PBP
Correction
705 A UI
Enrollment
PBP
Correction
UI ENROLL
CANCL
UI CNCL PBP
COR
UI ENR PBP COR
A CMS User cancelled the beneficiary’s existing enrollment and the beneficiary is disenrolled.
When an enrollment is cancelled, it means that the enrollment never occurred. TRR data record
field 18 contains the effective date (start date) of the cancelled enrollment period.
Plan Action: Remove the indicated enrollment from the Plan’s records. Take the appropriate
actions as per CMS enrollment guidance.
A CMS User updated the PBP on an existing enrollment. This generates two transaction replies, a
Transaction Type 51 with TRC 704 and a Transaction Type 61 with TRC 705. This reply with TRC
704 (Transaction Type 51) represents the cancellation of the enrollment in the original PBP. The
effective (start) and disenrollment (end) dates of the enrollment being cancelled are found in TRR
data record fields 18 & 24, respectively. When an enrollment is cancelled it means that the
enrollment never occurred.
Plan Action: Remove the indicated enrollment in the original PBP from the Plan’s records. Look
for the accompanying reply with TRC 705 to determine the replacement enrollment period. Take
the appropriate actions as per CMS enrollment guidance.
A CMS User updated the PBP on an existing enrollment. This generates two transaction replies, a
Transaction Type 51 with TRC 704 and a Transaction Type 61 with TRC 705. This reply with TRC
705 (Transaction Type 61) represents the enrollment in the new PBP. The effective (start) and
disenrollment (end) dates of the enrollment in this new PBP are found in TRR data record fields 18
& 24, respectively. This enrollment should replace the enrollment cancelled by the associated
Transaction Type 51 transaction (TRC 704).
The Part C Premium amount may have been populated automatically with the base Part C premium
amount.
Plan Action: Update the Plan records to reflect the beneficiary’s enrollment in the new Contract,
PBP. Look for the accompanying reply with TRC 704 to ensure that the original PBP enrollment
was cancelled. 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-77 Transaction Reply Codes (TRCs)