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 715 M Medicaid Change Accepted 716 I UI changed the Number of Uncovered Months 717 I UI changed only the Application Date MCAID CHG ACEPT UI CHGD NUNCMO UI CHGD APP DT A CMS User changed the beneficiary’s Medicaid status. This may or may not have changed the beneficiary’s actual status since multiple sources of Medicaid information are used to determine the beneficiary’s actual Medicaid status. The Plan will see the result of any changes to the beneficiary’s actual Medicaid status included in the next scheduled update of Medicaid status. Plan Action: Update the Plan’s records accordingly. A CMS User or Plan User with Update Authority updated the beneficiary’s Number of Uncovered Months. Plan Action: Update the Plan’s records accordingly. Ensure that the Plan is billing the correct amount for the LEP. Take the appropriate actions as per CMS enrollment guidance. A CMS User updated only the Application Date of a beneficiary's enrollment, which results in a blank TC on the DTRR, Field 16. Plan Action: Update the Plan’s records accordingly. December 28, 2012 I-81 Transaction Reply Codes (TRCs)
Plan Communications User Guide Appendices, Version 6.3 Code Type Title Short Definition Definition 718 I UI MMP Opt-Out Change Accepted 990 – 995 996 I EOY Loss of Low Income Subsidy Status UI MMP OPTOUT OK EOY LOSS SBSDY A CMS User or Plan User with Update Authority added or changed the value of the MMP Opt-Out Flag for this beneficiary. The new MMP Opt-Out Flag is reported in TRR data record field 70. The following fields populate in the daily TRR when this TRC is returned: Field 1: HICN Field 2: Surname Field 3: First Name Field 4: Middle Initial Field 5: Gender Code Field 6: Date of Birth Field 7: Record Type Field 8: Contract Number Field 9: State Code Field 10: County Code Field 15: Transaction Reply Code Field 16: Transaction Type Code Field 18: Request Effective Date Field 20: Plan Benefit Package ID Field 22: Transaction Date Field 28: Source ID Field 31: UI User Organization Designation Field 43: Processing Timestamp Field 68: TRC Short Name Field 70: MMP Opt Out Flag Field 72: System Assigned Transaction Tracking ID These codes appear only on special TRRs that are generated for specific purposes; for example, those generated to communicate Full Enrollment or to report beneficiaries losing low-income deeming. When a special TRR produces one of these TRCs, CMS will provide the Plans with communications which define the TRC descriptions and Plan actions (if applicable). Identifies those beneficiaries who are losing their deemed or LIS Applicant status as of December 31 st of the current year with no low income status determined for January of the following year. Plan Action: Update Plan records accordingly. December 28, 2012 I-82 Transaction Reply Codes (TRCs)
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Medicare Advantage and Prescription
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Plan Communications User Guide Appe
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F.28.3 Trailer Record Plan Communic
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CMS Transmittals to the Plans Plan
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ID# Transmittal Monthly Transmittal
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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