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 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)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 706 A UI Enrollment Cancel Segment Correction 707 A UI Enrollment Segment Correction 708 A UI Assigns End Date UI CNCL SEG COR UI ENR SEG COR UI ASSGN END DT A CMS User updated the Segment on an existing enrollment. This generates two transaction replies, a Transaction Type 51 with TRC 706 and a Transaction Type 61 with TRC 707. This reply (Transaction Type 51) represents the cancellation of the enrollment in the original Segment. When an enrollment is cancelled it means that the enrollment never occurred. The effective (start) and disenrollment (end) dates of the enrollment being cancelled are found in TRR data record fields 18 & 24, respectively. Plan Action: Remove the indicated enrollment in the original Segment from the Plan’s records. Look for the accompanying reply with TRC 707 to determine the replacement enrollment period. Take the appropriate actions as per CMS enrollment guidance. A CMS User updated the Segment on an existing enrollment. This generates two transaction replies, a Transaction Type 51 with TRC 706 and a Transaction Type 61 with TRC 707. This reply (Transaction Type 61) represents the enrollment in the new Segment. The effective (start) and disenrollment (end) dates of the enrollment in this new Segment 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 706). 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. Segment. Look for the accompanying reply with TRC 706 to ensure that the original Segment 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. A CMS User or Plan User with Update Authority assigned an end date to existing open-ended enrollment. The last day of enrollment is in TRR data record field 18. The enrollment effective date (start date) remains unchanged. Plan Action: Update the Plan records to reflect the beneficiary’s disenrollment from the Plan. Take the appropriate actions as per CMS enrollment guidance. December 28, 2012 I-78 Transaction Reply Codes (TRCs)
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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