Medicare Advantage and Prescription Drug Plans December 28 ...

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