Medicare Advantage and Prescription Drug Plans December 28 ...
Medicare Advantage and Prescription Drug Plans December 28 ...
Medicare Advantage and Prescription Drug Plans December 28 ...
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Plan Communications User Guide Appendices, Version 6.3<br />
ID# Transmittal<br />
Monthly Transmittals (Data &<br />
Reports)<br />
40<br />
41<br />
42<br />
43<br />
Monthly Membership Summary<br />
Data File<br />
PCUG Record Layout – F.9<br />
RAS RxHCC Model Output<br />
Report<br />
AKA: Part D Risk Adjustment<br />
Model Output Report<br />
PCUG Sample Report – J.9<br />
RAS RxHCC Model Output Data<br />
File<br />
AKA: Part D Risk Adjustment<br />
Model Output Data File<br />
Header Record<br />
Detail / Beneficiary Record Format<br />
Trailer Record<br />
PCUG Record Layout – F.13<br />
Part C Risk Adjustment Model<br />
Output Report<br />
PCUG Sample Report – J.8<br />
Description<br />
Data file version of the<br />
Monthly Membership<br />
Summary Report for both<br />
Part C <strong>and</strong> Part D members.<br />
Note:<br />
The date in the file name<br />
defaults to “01” denoting<br />
the first day of the current<br />
payment month<br />
Report showing the Part D<br />
risk adjustment factors for<br />
each beneficiary. MARx<br />
forwards this report that is<br />
produced by RAS to plans<br />
as part of the month-end<br />
processing.<br />
Note:<br />
The date in the file name<br />
defaults to “01” denoting<br />
the first day of the current<br />
payment month<br />
Data file version of the<br />
RAS RxHCC Model Output<br />
Report. MARx forwards<br />
this report that is produced<br />
by RAS to <strong>Plans</strong> as part of<br />
the month-end processing.<br />
Note:<br />
The date in the file name<br />
defaults to “01” denoting<br />
the first day of the current<br />
payment month<br />
Report showing the<br />
Hierarchical Condition<br />
Codes (HCCs) used by the<br />
Risk Adjustment System<br />
(RAS) to calculate Part C<br />
risk adjustment factors for<br />
each beneficiary. MARx<br />
forwards this report that is<br />
produced by RAS to plans<br />
as part of the month-end<br />
processing.<br />
Responsible<br />
System Type Freq. Dataset Naming Conventions<br />
MARx<br />
RAS<br />
(MARx)<br />
RAS<br />
(MARx)<br />
RAS<br />
(MARx)<br />
Data File Monthly<br />
Report<br />
(.pdf)<br />
Monthly<br />
Data File Monthly<br />
Report<br />
Monthly<br />
Gentran Mailbox/TIBCO MFT<br />
Internet Server:<br />
P.Fxxxxx.MONMEMSD.Dyymm01.<br />
Thhmmsst.pn<br />
P.Rxxxxx.MONMEMSD.Dyymm01.<br />
Thhmmsst.pn<br />
Connect:Direct (Mainframe):<br />
zzzzzzzz.Fxxxxx.MONMEMSD.Dyy<br />
mm01.Thhmmsst<br />
zzzzzzzz.Rxxxxx.MONMEMSD.Dyy<br />
mm01.Thhmmsst<br />
Connect:Direct (Non-Mainframe):<br />
[directory]Fxxxxx.MONMEMSD.Dy<br />
ymm01.Thhmmsst<br />
[directory]Rxxxxx.MONMEMSD.Dy<br />
ymm01.Thhmmsst<br />
Gentran Mailbox/TIBCO MFT<br />
Internet Server:<br />
P.Rxxxxx.PTDMODR.Dyymm01.Th<br />
hmmsst.pn<br />
Connect:Direct (Mainframe):<br />
zzzzzzzz.Rxxxxx.PTDMODR.Dyym<br />
m01.Thhmmsst<br />
Connect:Direct (Non-Mainframe):<br />
[directory]Rxxxxx.PTDMODR.Dyy<br />
mm01.Thhmmsst<br />
Gentran Mailbox/TIBCO MFT<br />
Internet Server:<br />
P.Rxxxxx.PTDMODD.Dyymm01.Th<br />
hmmsst.pn<br />
Connect:Direct (Mainframe):<br />
zzzzzzzz.Rxxxxx.PTDMODD.Dyym<br />
m01.Thhmmsst<br />
Connect:Direct (Non-Mainframe):<br />
[directory]Rxxxxx.PTDMODD.Dyy<br />
mm01.Thhmmsst<br />
Gentran Mailbox/TIBCO MFT<br />
Internet Server:<br />
P.Rxxxxx.HCCMODR.Dyymm01.Th<br />
hmmsst.pn<br />
Connect:Direct (Mainframe):<br />
zzzzzzzz.Rxxxxx.HCCMODR.Dyym<br />
m01.Thhmmsst<br />
Connect:Direct (Non-Mainframe):<br />
[directory]Rxxxxx.HCCMODR.Dyy<br />
mm01.Thhmmsst<br />
Note:<br />
The date in the file name<br />
defaults to “01” denoting<br />
the first day of the current<br />
payment month<br />
<strong>December</strong> <strong>28</strong>, 2012 K-9 All Transmissions Overview
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