Plan Communications User Guide Appendices, Version 6.3 J.6 Monthly Membership Summary Report (MMSR) Description This report summarizes payments to an MCO for the month, in several categories, <strong>and</strong> adjustments, by all adjustment categories. When the report automatically generates as part of month-end processing, it covers one contract in one payment month. When the report generates on user request, it is based on the transactions received to-date for the current payment month <strong>and</strong> may generate for one contract or for all contracts in a region. Example 1 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 3 1234567890123456789012345678901234567890123456789012345678901234567890123456789012345678901234567890123456789012345678901234567890123 RUN DATE:yyyymmdd MONTHLY MEMBERSHIP SUMMARY REPORT (PAGE 1 OF 2) PAYMENT MONTH:yyyymm PLAN: H9999 PBP(mmm) SEG(nnn) Name-of-Provider-Here CURRENT PAYMENTS PART A ---------- COUNTS ----- TOTAL MONEY PART B -------- COUNTS ----- TOTAL MONEY PART D ---------- COUNTS ----- TOTAL MONEY HOSPICE z,zzz,zz9 $$,$$$,$$$,$$9.99 HOSPICE z,zzz,zz9 $$,$$$,$$$,$$9.99 ESRD z,zzz,zz9 $$,$$$,$$$,$$9.99 ESRD z,zzz,zz9 $$,$$$,$$$,$$9.99 WA z,zzz,zz9 $$,$$$,$$$,$$9.99 WA z,zzz,zz9 $$,$$$,$$$,$$9.99 INST z,zzz,zz9 $$,$$$,$$$,$$9.99 INST z,zzz,zz9 $$,$$$,$$$,$$9.99 NHC z,zzz,zz9 $$,$$$,$$$,$$9.99 NHC z,zzz,zz9 $$,$$$,$$$,$$9.99 MCAID z,zzz,zz9 $$,$$$,$$$,$$9.99 MCAID z,zzz,zz9 $$,$$$,$$$,$$9.99 PART C PREMIUM z,zzz,zz9 $$,$$$,$$$,$$9.99 PART C PREMIUM z,zzz,zz9 $$,$$$,$$$,$$9.99 DIR SUBSDY z,zzz,zz9 $$,$$$,$$$,$$9.99 A/B COST SHR z,zzz,zz9 $$,$$$,$$$,$$9.99 A/B COST SHR z,zzz,zz9 $$,$$$,$$$,$$9.99 LIS COST SHR z,zzz,zz9 $$,$$$,$$$,$$9.99 A/B MAN SUP BN z,zzz,zz9 $$,$$$,$$$,$$9.99 A/B MAN SUP BN z,zzz,zz9 $$,$$$,$$$,$$9.99 ESTIMATD REINS z,zzz,zz9 $$,$$$,$$$,$$9.99 D BAS PRM REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 D BAS PRM REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 PACE PRM ADDON z,zzz,zz9 $$,$$$,$$$,$$9.99 D SUPP BENFITS z,zzz,zz9 $$,$$$,$$$,$$9.99 D SUPP BENFITS z,zzz,zz9 $$,$$$,$$$,$$9.99 PACE CSR ADDON z,zzz,zz9 $$,$$$,$$$,$$9.99 B BAS PRM REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 B BAS PRM REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 COV GAP DISC z,zzz,zz9 $$,$$$,$$$,$$9.99 A/D MSP REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 A/D MSP REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 LIPS z,zzz,zz9 $$,$$$,$$$,SS9.99 ESRD MSP REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 ESRD MSP REDU z,zzz,zz9 $$,$$$,$$$,$$9.99 MEMBERS z,zzz,zz9 $$,$$$,$$$,$$9.99 MEMBERS z,zzz,zz9 $$,$$$,$$$,$$9.99 MEMBERS z,zzz,zz9 $$,$$$,$$$,$$9.99 MONTHS z,zzz,zz9 MONTHS z,zzz,zz9 MONTHS z,zzz,zz9 AVERAGE $$$$,$$$,$$9.99 AVERAGE $$$$,$$$,$$9.99 AVERAGE $$$$,$$$,$$9.99 OUT OF AREA z,zzz,zz9 B PRM REDU - A $$,$$$,$$$,$$9.99 B PRM REDU - A $$,$$$,$$$,$$9.99 B PRM REDU - D $$,$$$,$$$,$$$.99 B PRM REDU - D $$,$$$,$$$,$$$.99 1 1 1 1 1 2 3 4 5 6 7 8 9 0 1 2 3 1234567890123456789012345678901234567890123456789012345678901234567890123456789012345678901234567890123456789012345678901234567890123 RUN DATE:yyyymmdd MONTHLY MEMBERSHIP SUMMARY REPORT (PAGE 2 OF 2) <strong>December</strong> <strong>28</strong>, 2012 J-15 MMSR
Plan Communications User Guide Appendices, Version 6.3 PAYMENT MONTH:yyyymm PLAN: H9999 PBP(mmm) SEG(nnn) Name-of-Provider-Here ADJUSTMENT PAYMENTS ADJ REA ADJUSTMENT NUMBER MONTHS MONTHS MONTHS ----------------------- ADJUSTMENT AMOUNT ------------------------ CDE DESCRIPTION OF ADJS A B D PART A PART B PART D TOTAL --- ------------------- ------- ------- ------- ------- ------------------ ------------------ ------------------ ------------------- 01 DEATH zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 02 RETRO ENROLL zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 03 RETRO DISENR zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 04 CORR ENROLL zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 05 CORRT DISENR zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 06 CORR PARTA E zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 07 HOSPC zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 08 ESRD zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 09 INSTNHC zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 10 MCAID zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 11 RETRO SCC CH zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 12 CORR DT. OF zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 13 CORR DT. OF zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 14 CORR SEX zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 18 AAPCC RT FAC zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 19 CORR PARTB E zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 20 WKAGE zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 21 INSTNHC zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- 22 DISENROLL PR zzzzzz9 zzzzzz9 zzzzzz9 zzzzzz9 $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$,$$$,$$$,$$9.99- $$$,$$$,$$$,$$9.99- <strong>December</strong> <strong>28</strong>, 2012 J-16 MMSR
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