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) 44 45 46 Part C Risk Adjustment Model Output Data File Header Record Detail Record Trailer Record PCUG Record Layout – F.12 BIPA 606 Payment Reduction Report PCUG Sample Report – J.1 BIPA 606 Payment Reduction Data File PCUG Record Layout – F.3 Description Data file version of the Risk Adjustment Model Output Report Note: The date in the file name defaults to “01” denoting the first day of the current payment month Report listing members for whom the plan is paying a portion of the Part B premium. Generated only if there are pre-2006 adjustments that involve BIPA 606 premium reductions. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Data file version of the BIPA 606 Reduction Report. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Responsible System Type Freq. Dataset Naming Conventions RAS (MARx) MARx MARx Data File Monthly Report Data File Monthly, if applicable Monthly, if applicable Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.HCCMODD.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.HCCMODD.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.HCCMODD.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.BIPA606R.Dyymm01.Thh mmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.BIPA606R.Dyymm 01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.BIPA606R.Dyym m01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.BIPA606D.Dyymm01.Thh mmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.BIPA606D.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.BIPA606D.Dyym m01.Thhmmsst 47 Bonus Payment Report PCUG Sample Report – J.2 Report listing members for whom the plan is to be paid a bonus. (Plans are paid a bonus for extending services to Beneficiaries in some underserved areas.) Generated only if there are pre-2006 adjustments that involve bonus payments. Note: The date in the file name defaults to “01” denoting the first day of the current payment month MARx Report Monthly, if applicable Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.BONUSRPT.Dyymm01.T hhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.BONUSRPT.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.BONUSRPT.Dyy mm01.Thhmmsst December 28, 2012 K-10 All Transmissions Overview
ID# Transmittal Monthly Transmittals (Data & Reports) 48 49 Bonus Payment Data File PCUG Record Layout – F.4 Monthly Summary of Bills Report PCUG Sample Report – J.7 50 HMO Bill Itemization Report PCUG Sample Report – J.3 Plan Communications User Guide Appendices, Version 6.3 Description Data file version of the Bonus Payment Report Note: The date in the file name will default to The date in the file name defaults to “01” denoting the first day of the current payment month Report summarizing all Medicare fee-for-service activity, both Part A and Part B, for Beneficiaries enrolled in the contract Note: The date in the file name defaults to “01” denoting the first day of the current payment month Report listing the Part A bills that were processed under Medicare fee-forservice for Beneficiaries enrolled in the contract. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Responsible System Type Freq. Dataset Naming Conventions MARx Data File Monthly, if applicable MARx Report Monthly MARx Report Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.BONUSDAT.Dyymm01.T hhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.BONUSDAT.Dyy mm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.BONUSDAT.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.SUMBILLS.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.SUMBILLS.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.SUMBILLS.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.BILLITEM.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.BILLITEM.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.BILLITEM.Dyym m01.Thhmmsst 51 Part B Claims Data File Record Type 1 Record Type 2 PCUG Record Layout – F.11 52 Payment Records Report PCUG Sample Report – J.10 Data file listing the Part B physician and supplier claims and Part B home health claims that were processed under Medicare fee-for-service for Beneficiaries enrolled in the contract. Note: The date in the file name defaults to “01” denoting the first day of the current payment month Report listing the Part B physician and supplier claims that were processed under Medicare fee-forservice for Beneficiaries enrolled in the contract. Note: The date in the file name defaults to “01” denoting the first day of the current payment month MARx Data File Monthly MARx Report Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.CLAIMDAT.Dyymm01.T hhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.CLAIMDAT.Dyy mm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.CLAIMDAT.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PAYRECDS.Dyymm01.T hhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PAYRECDS.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.PAYRECDS.Dyy mm01.Thhmmsst December 28, 2012 K-11 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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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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