Medicare Advantage and Prescription Drug Plans December 28 ...

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CMS Transmittals to the Plans Plan Communications User Guide Appendices, Version 6.3 System 16 Auto Assignment (PDP) Address Notification File Header Record Detail Record(s) Trailer Record PCUG Record Layout – F.24 Monthly file of addresses of Beneficiaries who have been either Auto Assigned or Facilitated Assigned to PDPs MBD Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.#APDP4.Dyymmdd.Thhm msst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.#APDP4.Dyymmd d.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.#APDP4.Dyymm dd.Thhmmsst 17 NoRx File Header Record Detail Record Trailer Record PCUG Record Layout – F.20 File containing records identifying those enrollees that do not currently have 4Rx information stored in CMS files. A Detail Record Type containing a value of “NRX” in positions 1 – 3 of the file layout will indicate that this record is a request for your organization to send CMS 4Rx information for the beneficiary. MBD Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.#NORX.Dyymmdd.Thhm msst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.#NORX.Dyymmdd .Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.#NORX.Dyymmd d.Thhmmsst 18 19 Batch Eligibility Query (BEQ) Request File Acknowledgment (Accept/Reject) PCUG Sample Report – J.14 Batch Eligibility Query (BEQ) Response File Header Record Detail Record (Transaction) Trailer Record PCUG Record Layout – F.22 MBD will determine if a BEQ Request File is Accepted or Rejected. MBD will issue an e-mail acknowledgment of receipt and status to the Sending Entity. If Accepted the file will be processed. If Rejected, the e-mail shall inform the Sending Entity of the first File Error Condition that caused the BEQ Request File to be Rejected. A rejected file will not be returned. File containing records produced as a result of processing the transactions of accepted BEQ Request files. Detail records for all submitted records that were successfully processed will contain Processed Flag = Y. Detail records for all submitted records that were not successfully processed contain Processed Flag = N. MBD E-mail Response to BEQ MBD Data File Response to BEQ N/A Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.#BQN4.Dyymmdd.Thhm msst.pn Connect:Direct [Mainframe]: zzzzzzzz.Rxxxxx.#BQN4.Dyymmdd. Thhmmsst Connect:Direct [Non-mainframe]: [directory]Rxxxxx.#BQN4.Dyymmd d.Thhmmsst December 28, 2012 K-4 All Transmissions Overview
Plan Communications User Guide Appendices, Version 6.3 ID# Transmittal CMS Transmittals to the Plans Description Responsible System Type Freq. Dataset Naming Conventions 20 ECRS Data File File containing errors and statuses of ECRS submissions. ECRS Data File Daily Gentran Mailbox/TIBCO MFT Internet Server: PCOB.BA.ECRS.ccccc.RESPONSE. ssssss Connect:Direct: TRANSMITTED FROM GHI 21 Prescription Drug Event (PDE) PDFS Response Data File File containing responses if files are accepted or rejected. PDE Data File Daily Gentran Mailbox/TIBCO MFT Internet Server: RSP.PDFS_RESP_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO 22 23 Prescription Drug Event (PDE) Drug Data Processing System (DDPS Return Data File Prescription Drug Event (PDE) DDPS Transaction Error Summary Data File File provides feedback on every record processed in a batch. Up to 10 specific errors are reported for each PDE in the file. File provides frequency of occurrence for each error code encountered during the processing of a PDE file. The percentage to the total errors is also computed and displayed for each error code. PDE Data File Daily PDE Data File Daily Gentran Mailbox/TIBCO MFT Internet Server: RPT.DDPS_TRANS_VALIDATION _ssssss Connect:Direct: TRANSMITTED FROM PALMETTO Gentran Mailbox/TIBCO MFT Internet Server: RPT.DDPS_ERROR_SUMMARY_s sssss Connect:Direct: TRANSMITTED FROM PALMETTO 24 Front-End Risk Adjustment System (FERAS) Response Reports Report indicates that the file was accepted or rejected by the Front-End Risk Adjustment System. FERAS Report Daily Gentran Mailbox/TIBCO MFT Internet Server: RSP.FERAS_RESP_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO 25 Front-End Risk Adjustment System (FERAS) Response Data Files File contains all of the submitted transactions whether or not the file contains errors. FERAS Data File Daily Gentran Mailbox/TIBCO MFT Internet Server: RPT.RAPS_RETURN_FLAT_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO 26 Front-End Risk Adjustment System (FERAS) Response Reports Transaction Error Report Report lists the transactions that contained errors and identifies the errors found. FERAS Report Daily Gentran Mailbox/TIBCO MFT Internet Server: RPT.RAPS_ERRORRPT_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO December 28, 2012 K-5 All Transmissions Overview
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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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Item # Plan Communications User Gui
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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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