Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F: Record Layouts
This appendix provides record layouts for data files exchanged with Plans. Field lengths, formats, and descriptions
are included along with expected values where applicable. Table F-1 below lists the names of all the layouts and on
which page of Appendix F to find them. Appendix K identifies the naming conventions of for all files exchanged
between CMS and the Plans.
Table F-1: Record Layouts Lookup Table
Section Name Page
F.1 820 Format Payment Advice Data File F-3
F.2 Batch Completion Status Summary Data File F-7
F.3 BIPA 606 Payment Reduction Data File F-8
F.4 Bonus Payment Data File F-9
F.5 Coordination of Benefits (COB) Validated Other Insurer Information Data File F-10
F.6 MARx Batch Input Transaction Data File F-17
F.6.1 Header Record F-17
F.6.2 Disenrollment Transaction (TC 51/54) F-18
F.6.3 Enrollment Transaction (TC 61) F-19
F.6.4.1 RX Change (TC 72) F-22
F.6.4.2 NUNCMO Change (TC 73) F-23
F.6.4.3 EGHP Change (TC 74) F-24
F.6.4.4 Premium Payment Option (POP) Change (TC 75) F-24
F.6.4.5 Residence Address Change (TC 76) F-25
F.6.4.6 Segment ID Change (TC 77) F-26
F.6.4.7 Part C Premium Change (TC 78) F-26
F.6.4.8 Part D Opt-Out Change (TC 79) F-27
F.6.5.1 Cancel Enrollment (TC 80) F-28
F.6.5.2 Cancel Disenrollment (TC 81) F-28
F.6.5.3 MMP Enrollment Cancellation (TC 82) Detail Record Layout F-29
F.6.5.4 MMP Opt-Out Update (TC 83) Layout F-29
F.6.6 Correction Record F-30
F.6.7 Notes for All Plan-Submitted Transaction Types F-31
F.7 Failed Transaction Data File - OBSOLETE F-35
F.8 Monthly Membership Detail Data File F-36
F.9 Monthly Membership Summary Data File F-44
F.10 Monthly Premium Withholding Report Data File (MPWR) F-47
F.11 Part B Claims Data File F-50
F.12 Part C Risk Adjustment Model Output Data File F-52
F.13
RAS RxHCC Model Output Data File aka Part D Risk Adjustment Model Output
Data File
F-59
F.14 Daily Transaction Reply Report (DTRR) Data File F-81
F.14.1 DTRR Data File Detailed Record Layout F-81
F.14.2 Verbatim Plan Submitted Transaction on Transaction Reply Report F-89
F.15 Monthly Full Enrollment Data File F-89
December 28, 2012 F-1 Record Layouts