Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
I.6 MMR Adjustment Reason Codes
Table I-5 lists the adjustment reasons and their associated codes.
Table I-5: Adjustment Reason Codes
Code
Description
01 Notification of Death of Beneficiary
02 Retroactive Enrollment
03 Retroactive Disenrollment
04 Correction to Enrollment Date
05 Correction to Disenrollment Date
06 Correction to Part A Entitlement
07 Retroactive Hospice Status
08 Retroactive ESRD Status
09 Retroactive Institutional Status
10 Retroactive Medicaid Status
11 Retroactive Change to State County Code
12 Date of Death Correction
13 Date of Birth Correction
14 Correction to Sex Code
15 Obsolete
16 Obsolete
17 For APPS use only
18 Part C Rate Change
19 Correction to Part B Entitlement
20 Retroactive Working Aged Status
21 Retroactive NHC Status
22 Disenrolled Due to Prior ESRD
23 Demo Factor Adjustment
24 Retroactive Change to Bonus Payment
25 Part C Risk Adj Factor Change/Recon
26 Mid-year Part C Risk Adj Factor Change
27 Retroactive Change to Congestive Heart Failure (CHF) Payment
28 Retroactive Change to BIPA Part B Premium Reduction Amount
29 Retroactive Change to Hospice Rate
30 Retroactive Change to Basic Part D Premium
31 Retroactive Change to Part D Low Income Premium Subsidy Change
32 Retroactive Change to Estimated Cost-Sharing Amount
33 Retroactive Change to Estimated Reinsurance Amount
34 Retroactive Change Basic Part C Premium
December 28, 2012 I-101 MMR Adjustment
Reason Codes