Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Code Type Title Short Definition Definition
057 M Risk Adjuster Factor
Change
111 R PBP Rejected; Invalid
Contract Number
112 R Rejected; Conflicting
Effective Dates
115 R Enrollment Rejected;
Plan Not Open
OBSOLETE
OBSOLETE
OBSOLETE
OBSOLETE
This is an informational TRC.
The Risk Adjuster System (RAS) has created new factors for this beneficiary, which
may result in payment adjustments.
Plan Action: Refer to the monthly RAS reports to update the Plan’s records.
A PBP enrollment change transaction (Transaction Type 61) was rejected because the
contract number submitted on the transaction does not match the contract number of
the Plan in which the beneficiary is currently enrolled. The requested effective date of
enrollment in the new PBP is reported in TRR data file field 18.
Plan Action: If appropriate, resubmit the transaction with the correct contract
number. If the Plan is attempting to move the beneficiary to a new contract number,
an enrollment transaction (Transaction Type 61) must be used.
A PBP change transaction (Transaction Type 61) was rejected because beneficiary
was not enrolled in the submitted contract as of the effective date for the PBP change.
A beneficiary must be enrolled in a PBP of a contract in order to change to another
PBP. The effective date of the enrollment within the contract must be equal to or
before the effective date of the PBP change.
Plan Action: Correct the effective date of the PBP Change transaction and resubmit
if appropriate. If the Plan is attempting to enroll a beneficiary in a different PBP with
an effective date earlier than the original enrollment, the Plan must us an Enrollment
transaction (Transaction Type 61).
An enrollment or PBP change transaction (Transaction Type 61) was rejected because
this Plan is closed to enrollments using an O (OEP), N (OEPNEW) or OEPI (T)
election type.
Plan Action: Correct the enrollment type and resubmit the transaction if appropriate.
December 28, 2012 I-85 Obsolete Transaction Reply Code (TRCs)