Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 062 R CORRECTION REJECTED, OVERLAPS OTHER PERIOD 075 A INSTITUTIONAL STATUS SET 079 M PART A TERMINATION 080 M PART A REINSTATEMENT 081 M PART B TERMINIATION 082 M PART B REINSTATEMENT 086 M CLAIM NUMBER CHANGE 087 M NAME CHANGE 088 M SEX CODE CHANGE 089 M DATE OF BIRTH CHANGE 090 M DATE OF DEATH ESTABLISHED 091 M DATE OF DEATH REMOVED 092 M DATE OF DEATH CORRECTED 121M LOW INCOME PERIOD STATUS 152 M RACE CODE CHANGE 154M OUT OF AREA STATUS 155 M INCARCERATION NOTIFICATION RECEIVED 158 M INSTITUTIONAL PERIOD CHANGE/CANCELLATION 159 M NURSING HOME CERT PERIOD CHANGE/CANCELLATION 165 R PROCESSING DELAYED DUE TO MARX SYSTEM PROBLEMS 194M DEEMED CORRECTION 197M PART D ELIGIBILITY TERMINATION 198M PART D ELIGIBILITY REINSTATEMENT 267M PREMIUM PAYMENT OPTION SET TO "N" DUE TO NO PREMIUM 270M BENEFICIARY TRANSPLANT HAS ENDED December 28, 2012 I-99 TRC Groupings
Plan Communications User Guide Appendices, Version 6.3 I.5 Payment Reply Codes Table I-4 lists the reply codes returned for transactions found in Table I-1. PRC Types: A - Accepted - A transaction is accepted and the requested action is applied (Example: enrollment or disenrollment) R - Rejected - A transaction is rejected due to an error or other condition. The requested action is not applied to the CMS System. The TRC code indicates the reason for the transaction rejection. The Plan should analyze the rejection to validate the submitted transaction and to determine whether to resubmit the transaction with corrections. I - Informational - These replies accompany Accepted TRC replies and provide additional information about the transaction or Beneficiary. For example: If an enrollment transaction for a Beneficiary who is “out of area” is accepted, the Plan receives an accepted TRC (TRC 011) and an additional reply is included in the TRR that gives the Plan the additional information that the Beneficiary is “Out of Area” (TRC 016). M - Maintenance - These replies provide information to Plans about their Beneficiaries enrolled in their Plan. They are sent in response to information received by CMS. For example: If CMS is informed of a change in a Beneficiary’s claim number, a reply is included in the Plan’s TRR with TRC 086, giving the Plan the new claim number. F - Failed - A transaction failed due to an error or other condition and the requested action did not occur. The TRC code indicates the reason for the transaction’s failure. The Plan should analyze the failed transaction and determine whether to resubmit with corrections. Table I-4: Payment Reply Codes Code/Type* Title Short Definition Definition 000 I 264 I 299 I No Data to Report Payment Not Yet Completed Correction to Previously Failed Payment NO REPORT Monthly Payment Exception Report: On the MPER it indicates the presence of all prospective payments for the plan (contract/PBP), none are missing. Plan Action: None NO PAYMENT A transaction was accepted requiring a payment calculation. The calculation has not been completed. Plan Action: None RESTORED PYMT A previously incomplete payment calculation is now completed. Plan Action: None required. December 28 , 2012 I-100 Payment Reply Codes
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F.10.3 Trailer Record Plan Communic
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F.11.2 Record Type 2 Plan Communica
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F.23.2 Detail Record (Transaction)
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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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