Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Example of BEQ Request File “Fail” Acknowledgment TO: Jim.Doe@xxs.net TO: Chris.Doe@dxxx.org TO: Falcon.Doe@xxxx.org TO: eevs.helpdesk@ngc.com FROM: MBD#BQ30.HCFJES@cms.hhs.gov Subject: CMS MMA DATA EXCHANGE FOR MMABTCH MMABTCH file has been received and failed surface edits by CMS. QUESTIONS? Contact 1-800-927-8069 or E-mail mapdhelp@cms.hhs.gov INPUT HEADER RECORD MMABEQRHH0030 20070228 84433346 INPUT TRAILER RECORD MMABEQRTH0030 20070221 844333460074065 THE TRAILER RECORD IS INVALID December 28, 2012 J-37 Sample BEQ Request File Pass and Fail Acknowledgments
Plan Communications User Guide Appendices, Version 6.3 K: All Transmissions Overview Table K-1: All Transmissions Overview ID# Transmittal Dataset naming conventions key: [GUID] = 7 character IACS User ID P = Production Data [.ZIP] = Appended if the file is compressed [directory] = optional directory specification from non-mainframe C:D clients (if present, may consist of up to 60 characters). If none exists, directory defaults to the constant “EFTO.” for Production files and "EFTT." for Test files. Plan Submittals to CMS 1 MARx Batch Input Transaction Data File Header Record Enrollment Transaction (Employer & Plan - 61 Detail Record Disenrollment Transaction (51/54) Detail Record Plan Elections (PBP Change) Transaction (71) Detail Record 4Rx Data Update (72) NUNCMO Update (73) Other Enrollment record Update (74) Premium Withhold Option Update (75) Description pn = Processing number of varying length assigned to the file by Gentran ccccc = Contract number Pccccc = Plan Contract Number for C:D Uuuu-uuuuuuu = 4-7 character transmitter RACF ID xxxxx = 5 character Contract ID yyyymmdd = Calendar year, month & day yymmdd = two digit year, month, day zzzzzzzz = Plan-provided high level qualifier eeee = Year for which final yearly RAS file was produced vvvvv = Sequence counter for final yearly RAS files Enrollment Transaction file to CMS MARx system requesting new enrollment, disenrollment, changes, etc. Only the 1-800-Medicare group submits a Part D Opt-Out (41) transaction. Responsible System Type Freq. Dataset Naming Conventions MARx Data File Annnnn & Bnnnnn = MARx batch transaction ID, nnnnnnnnnn split into two nodes A…and B …with leading zeroes as necessary to complete tencharacter batch ID hhmm = hour and minute ssssss= Sequentially assigned number mmyyyy = Calendar month & year hlq = High Level Qualifier or Directory per VSAM File freq = Frequency code of file Batch - Daily PRN Gentran Mailbox/TIBCO MFT Internet Server: [GUID].[RACFID].MARX.D.xxxx x.FUTURE.[P/T][.ZIP] Note: FUTURE is part of the filename and does not change. Connect:Direct: P#EFT.IN.uuuuuuu.MARXTR.DY YMMDD.THHMMSST Note: DYYMMDD.THHMMSST must be coded as shown, as it is a literal PCUG Record Layout – F.6 2 Batch Eligibility Query (BEQ) Request File Header Record Detail Record Trailer Record PCUG Record Layout – F.21 File of transactions submitted by Plans to request eligibility information for prospective Plan enrollees. Used to do initial eligibility checks against CMS MBD system to verify member is Part A./B eligible MBD Data File PRN (Plans can send multiple files in a day) Gentran Mailbox/TIBCO MFT Internet Server: [GUID].[RACFID].MBD.D.xxxxx. BEQ.[P/T][.ZIP] Connect:Direct: P#EFT.IN.PLxxxxx.BEQ4RX.DY YMMDD.THHMMSST Note: DYYMMDD.THHMMSST must be coded as shown, as it is a literal 3 Electronic Correspondence Referral System (ECRS) Batch Submittal File File used by Plans to submit other healthcare information (OHI) to CMS (rather than submittal through the ECRS online system) ECRS Data File Daily Gentran Mailbox/TIBCO MFT Internet Server: [GUID].[RACFID].ECRS.D.ccccc. FUTURE.[P/T] [.ZIP] Connect:Direct: TRANSMITTED TO GHI 4 Prescription Drug Event (PDE) Submittal File File of transactions submitted by the Plans with Prescription Drug Events. PDE Data File Can be Daily Gentran Mailbox/TIBCO MFT Internet Server: [GUID].[RACFID].PDE.D.ccccc.F UTURE.[P/T] [.ZIP] Connect:Direct: TRANSMITTED TO PALMETTO December 28, 2012 K-1 All Transmissions Overview
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Medicare Advantage and Prescription
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Plan Communications User Guide Appe
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F.10.3 Trailer Record Plan Communic
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F.11.2 Record Type 2 Plan Communica
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F.21.2 Detail Record (Transaction)
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F.23.2 Detail Record (Transaction)
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Item # Plan Communications User Gui
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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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