Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Section Name Page F.16 Low Income Subsidy (LIS)/Late Enrollment Penalty (LEP) Data File F-92 F.17 Loss of Subsidy Data File F-95 F.18 LIS/Part D Premium Data File F-97 F.19 LIS History Data File (LISHIST) F-98 F.20 NoRx File F-102 F.21 Batch Eligibility Query (BEQ) Request File F-106 F.22 Batch Eligibility Query (BEQ) Response File F-109 F.23 MA Full Dual Auto Assignment Notification File F-122 F.24 Auto Assignment PDP Address Notification File F-125 F.25 Plan Payment Report (PPR) / Interim Plan Payment Report (IPRR) Data File F-129 F.26 Long-Term Institutionalized Resident Report Data File F-138 F.27 Agent Broker Compensation Report Data File F-140 F.28 Monthly Medicare Secondary Payer (MSP) Information Data File F-142 F.29 Other Health Coverage Information Data File F-144 F.30 No Premium Due Data File Layout F-150 F.31 Failed Payment Reply Report Data File F-152 F.32 Missing Payment Exception Report F-153 December 28, 2012 F-2 Record Layouts
Plan Communications User Guide Appendices, Version 6.3 F.1 820 Format Payment Advice Data File The 820 Format Payment Advice data file is a Health Insurance Portability & Accountability Act (HIPAA)-compliant version of the Plan Payment Report, which is also known as the Automated Plan Payment System (APPS) Payment Letter. The data file itemizes the final monthly payment to the Plan. It is produced by APPS when final payments are calculated, and is available to Plans as part of the month-end processing. This file is not available through Medicare Advantage and Prescription Drug System (MARx). The following records are included in this file: Header Record (numbers 1-6 below) Detail Record (numbers 7-10 below) Summary Record (number 11 below) The segments are listed in a required order: 1. ST, 820 Header 2. BPR, Financial Information 3. TRN, Re-association Key 4. DTM, Coverage Period 5. N1, Premium Receiver’s Name 6. N1, Premium Payer’s Name 7. RMR, Organization Summary Remittance Detail 8. IT1, Summary Line Item 9. SLN, Member Count 10. ADX, Organization Summary Remittance Level Adjustment 11. SE, 820 Trailer The physical layout of a segment is: Segment Identifier, an alphanumeric code, followed by Each selected field (data element) preceded by a data element separator (“*”) And terminated by a segment terminator (“~”). Fields are mostly variable in length and do not contain leading/trailing spaces. If fields are empty, they are skipped by inserting contiguous data element separators (“*”) unless they are at the end of the segment. Fields that are not selected are represented in the same way as fields that are selected, but as this particular iteration of the transaction set contain no data, they are skipped. For example, in fictitious segment XXX, fields 2, 3, and 5 (the last field) are skipped: BALANCING REQUIREMENTS 1 XXX*field 1 content***field 4 content~ 1 See pp.16 in National EDI Transaction Set Implementation Guide for 820, ASCX12N, 820 (004010X061), dated May 2000 December 28, 2012 F-3 820 Format Payment Advice Data File
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F.28.3 Trailer Record Plan Communic
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I.3 Obsolete Transaction Reply Code
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Medicare Advantage and Prescription Drug Plans December 28 ...

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