Medicare Advantage and Prescription Drug Plans December 28 ...

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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
Plan Communications User Guide Appendices, Version 6.3 Code Description 35 Retroactive Change to Rebate Amount 36 Part D Rate Change 37 Part D Risk Adjustment Factor Change 38 Part C Segment ID Change 41 Part D Risk Adjustment Factor Change (ongoing) 42 Retroactive MSP Status 43 Retroactive Plan Premium Waiver Update 44 Retroactive correction of previously failed Payment (affects Part C and D) 45 Disenroll for Failure to Pay Part D IRMAA Premium – Reported for Pt C and Pt D 46 Correction of Part D Eligibility – Reported for Pt D 50 Payment adjustment due to Beneficiary Merge 90 System of Record History Alignment 94 Special Payment Adjustment Due to Clean-Up December 28, 2012 I-102 MMR Adjustment Reason Codes
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Medicare Advantage and Prescription Drug Plans December 28 ...

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