Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 ID# Transmittal Monthly Transmittals (Data & Reports) Description Responsible System Type Freq. Dataset Naming Conventions 37 Part D Monthly Membership Detail Report (Drug Report) aka: Monthly Membership Report (MMR) PCUG Sample Report – J.4 Report listing every Part D Medicare member of the contract and provides details about the payments and adjustments made for each. Note: The date in the file name defaults to “01” denoting the first day of the current payment month MARx Report Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Fxxxxx.MONMEMDR.Dyymm01. Thhmmsst.pn P.Rxxxxx.MONMEMDR.Dyymm01. Thhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Fxxxxx.MONMEMDR.Dyy mm01.Thhmmsst zzzzzzzz.Rxxxxx.MONMEMDR.Dy ymm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Fxxxxx.MONMEDR.Dyy mm01.Thhmmsst [directory]Rxxxxx.MONMEDR.Dyy mm01.Thhmmsst 38 Monthly Membership Detail Data File PCUG Record Layout – F.8 Data file version of the Monthly Membership Detail Reports. This file contains the data for both Part C and Part D members. Note: The date in the file name defaults to “01” denoting the first day of the current payment month MARx Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Fxxxxx.MONMEMD.Dyymm01.T hhmmsst.pn P.Rxxxxx.MONMEMD.Dyymm01.T hhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Fxxxxx.MONMEMD.Dyy mm01.Thhmmsst zzzzzzzz.Rxxxxx.MONMEMD.Dyy mm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Fxxxxx.MONMEMD.Dyy mm01.Thhmmsst [directory]Rxxxxx.MONMEMD.Dyy mm01.Thhmmsst 39 Monthly Membership Summary Report PCUG Sample Report – J.6 Report summarizing payments to a Plan for the month, in several categories, and adjustments, by all adjustment categories. This report contains data for both Part C and Part D members. Note: The date in the file name defaults to “01” denoting the first day of the current payment month MARx Report Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Fxxxxx.MONMEMSR.Dyymm01. Thhmmsst.pn P.Rxxxxx.MONMEMSR.Dyymm01. Thhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Fxxxxx.MONMEMSR.Dyy mm01.Thhmmsst zzzzzzzz.Rxxxxx.MONMEMSR.Dyy mm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Fxxxxx.MONMEMSR.Dy ymm01.Thhmmsst [directory]Rxxxxx.MONMEMSR.Dy ymm01.Thhmmsst December 28, 2012 K-8 All Transmissions Overview
Plan Communications User Guide Appendices, Version 6.3 ID# Transmittal Monthly Transmittals (Data & Reports) 40 41 42 43 Monthly Membership Summary Data File PCUG Record Layout – F.9 RAS RxHCC Model Output Report AKA: Part D Risk Adjustment Model Output Report PCUG Sample Report – J.9 RAS RxHCC Model Output Data File AKA: Part D Risk Adjustment Model Output Data File Header Record Detail / Beneficiary Record Format Trailer Record PCUG Record Layout – F.13 Part C Risk Adjustment Model Output Report PCUG Sample Report – J.8 Description Data file version of the Monthly Membership Summary Report for both Part C and Part D members. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Report showing the Part D risk adjustment factors for each beneficiary. MARx forwards this report that is produced by RAS to plans as part of the month-end processing. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Data file version of the RAS RxHCC Model Output Report. MARx forwards this report that is produced by RAS to Plans as part of the month-end processing. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Report showing the Hierarchical Condition Codes (HCCs) used by the Risk Adjustment System (RAS) to calculate Part C risk adjustment factors for each beneficiary. MARx forwards this report that is produced by RAS to plans as part of the month-end processing. Responsible System Type Freq. Dataset Naming Conventions MARx RAS (MARx) RAS (MARx) RAS (MARx) Data File Monthly Report (.pdf) Monthly Data File Monthly Report Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Fxxxxx.MONMEMSD.Dyymm01. Thhmmsst.pn P.Rxxxxx.MONMEMSD.Dyymm01. Thhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Fxxxxx.MONMEMSD.Dyy mm01.Thhmmsst zzzzzzzz.Rxxxxx.MONMEMSD.Dyy mm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Fxxxxx.MONMEMSD.Dy ymm01.Thhmmsst [directory]Rxxxxx.MONMEMSD.Dy ymm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PTDMODR.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PTDMODR.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.PTDMODR.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PTDMODD.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PTDMODD.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.PTDMODD.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.HCCMODR.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.HCCMODR.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.HCCMODR.Dyy mm01.Thhmmsst Note: The date in the file name defaults to “01” denoting the first day of the current payment month December 28, 2012 K-9 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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I.3 Obsolete Transaction Reply Code
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Medicare Advantage and Prescription Drug Plans December 28 ...

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