Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 J: Report Files This appendix provides a description and sample snapshot of each report file. Table J-1 lists the names of all the accessible reports to Plans and on which page of this appendix J they are located. Note that the examples provided for the reports do not identify any person living or dead; all Beneficiary, contract, and user information is fictional. Appendix J identifies the naming conventions for all reports sent to Plans. The user needs dataset names to request a report through the mainframe. Table J-1: Reports Lookup Table Section Name Page J.1 BIPA 606 Payment Reduction Report J-2 J.2 Bonus Payment Report J-6 J.3 HMO Bill Itemization Report J-11 J.4 Monthly Membership Detail Report – Drug Report (Part D) J-12 J.5 Monthly Membership Detail Report – Non Drug Report (Part C) J-13 J.6 Monthly Membership Summary Report J-15 J.7 Monthly Summary of Bills Report J-19 J.8 Part C Risk Adjustment Model Output Report J-21 J.9 RAS RxHCC Model Output Report J-22 AKA - Part D Risk Adjustment Model Output Report J.10 Payment Records Report J-23 J.11 Plan Payment Report (PPR) (APPS Payment Letter) J-24 J.12 Interim Plan Payment Report (IPPR) J-29 J.13 No Premium Due Report Format J-30 J.14 Sample BEQ Request File Pass and Fail Acknowledgement J-36 Note: See Appendix K for complete information on Dataset Names. December 28, 2012 J-1 Report Files
Plan Communications User Guide Appendices, Version 6.3 J.1 BIPA 606 Payment Reduction Report Description This report lists members for whom the MCO is paying a portion of the Part B premium. This report only reflects data for periods prior to 2006. Example 1 RUN DATE: 2003/12/10 PAY MONTH: 2004/01 BIPA606 PAYMENT REDUCTION REPORT PAGE: 1 CONTRACT#: H3333 REPORT DATE: 2003/12/10 0 PBP ID: 026 0 CLAIM SURNAME F S BIRTH ADJ PAY/ADJ BIPA BLEND TOT BIPA BLEND BLEND PT-B BLEND TOT NUMBER I E DATE RC DATES RATE W/O BIPA AMOUNT PT-A PLUS BIPA PLUS BIPA X 123456789A PARR H F 19121128 200401-200401 31.25 609.52 -31.25 362.64 215.63 578.27 123456789A MONET M F 19170402 200401-200401 31.25 677.32 -31.25 400.05 246.02 646.07 123456789D GARRISO M F 19130812 200401-200401 31.25 744.55 -31.25 437.15 276.15 713.30 123456789A GEISEL A M 19190407 200401-200401 31.25 687.28 -31.25 387.95 268.08 656.03 123456789A BLAZE H M 19170901 200401-200401 31.25 688.39 -31.25 406.45 250.69 657.14 123456789D AMES E F 19061027 200401-200401 31.25 607.62 -31.25 361.59 214.78 576.37 123456789D KLEIN P F 19270531 200401-200401 31.25 459.05 -31.25 243.34 184.46 427.80 123456789A DAVIDS J M 19200513 200401-200401 31.25 787.43 -31.25 444.78 311.40 756.18 123456789B DAVIDS E F 19180521 200401-200401 31.25 744.30 -31.25 443.28 269.77 713.05 123456789A MURRAY E F 19190614 200401-200401 31.25 724.95 -31.25 418.69 275.01 693.70 123456789A MURDOCK P M 19161126 200401-200401 31.25 734.80 -31.25 433.85 269.70 703.55 123456789D TROTTER S F 19230411 200401-200401 31.25 905.11 -31.25 518.10 355.76 873.86 123456789A RUSS D M 19220119 200401-200401 31.25 860.56 -31.25 486.14 343.17 829.31 123456789A PRINCE A F 19041104 200401-200401 31.25 646.97 -31.25 384.27 231.45 615.72 123456789A LONG I M 19190101 200401-200401 31.25 723.08 -31.25 427.31 264.52 691.83 123456789A SHAPIRO S M 19100313 200401-200401 31.25 858.29 -31.25 506.54 320.50 827.04 December 28, 2012 J-2 BIPA 606 Payment Reduction Report
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