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) 53 54 55 56 Monthly Premium Withholding Report Data File (MPWR) Header Record Detail Record Trailer - T1 - Total at segment level Trailer - T2 - Total at PBP level Trailer - T3 - Total at contract level PCUG Record Layout – F.10 Failed Payment Reply Report Detail Record PCUG Record Layout – F.31 Plan Payment Report (APPS Payment Letter) PCUG Sample Report – J.11 Plan Payment Report (APPS Payment Letter) Data File PCUG Record Layout – F.25 Description Monthly reconciliation file of premiums withheld from SSA, RRB, or OPM checks. Includes Part C and Part D premiums and any Part D Late Enrollment Penalties. This file is produced by the Premium Withhold System (PWS). MARx makes this report available 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 reporting payment actions which failed to complete. Report itemizing the final monthly payment to the plan. This report is produced by the APPS when final payments are calculated. MARx makes this report available 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 This data file itemizes the final monthly payment to the MCO. This data file and subsequent report is produced by the APPS when final payments are calculated. CMS makes this report available to MCO’s as part of month-end processing. 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 PWS (MARx) MARx Data File Monthly Data File Monthly Payment Cycle APPS Report Monthly APPS Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.MPWRD.Dyymm01.Thhm msst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.MPWRD.Dyymm0 1.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.MPWRD.Dyymm 01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.FPRRD.Dyymm01.Thhm msst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx FPRRD.Dyymm01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx. FPRRD.Dyymm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Fxxxxx.PLANPAY.Dyymm01.Thh mmsst.pn P.Rxxxxx.PLANPAY.Dyymm01.Thh mmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Fxxxxx.PLANPAY.Dyym m01.Thhmmsst zzzzzzzz.Rxxxxx.PLANPAY.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Fxxxxx.PLANPAY.Dyym m01.Thhmmsst [directory]Rxxxxx.PLANPAY.Dyym m01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PPRD.Dyymm01.Thhmms st.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PPRD.Dyymm01.T hhmmsst Connect:Direct (Non-Mainframe): [directory].Rxxxxx.PPRD.Dyymm01. Thhmmsst December 28, 2012 K-12 All Transmissions Overview
ID# Transmittal Monthly Transmittals (Data & Reports) 57 58 59 60 61 Interim APPS Plan Payment Report PCUG Sample Report – J.12 Interim APPS Plan Payment Report Data File PCUG Sample Layout – F.25 820 Format Payment Advice Data File PCUG Record Layout – F.1 Monthly Full Enrollment Data File PCUG Record Layout – F.15 Prescription Drug Event (PDE) DBC Cumulative Beneficiary Summary Report Plan Communications User Guide Appendices, Version 6.3 Description When a Plan is approved for an interim payment outside of the normal monthly process, an interim Plan Payment Report is distributed to that Plan. The report contains the amount and reason for the interim payment. Plans can also request these reports via the MARx user interface under the weekly report section of the menu. The Interim APPS Plan Payment Data File and Report is provided when a Plan is approved for an interim payment outside of the normal monthly process. The data file / report contains the amount and reason for the interim payment to the Plan. HIPAA-Compliant version of the Plan Payment Report. This data file itemizes the final monthly payment to the plan. This data file is not available through MARx. Note: The date in the file name defaults to “01” denoting the first day of the CCM File includes all active Plan membership on the date the file is run. This file is considered a definitive statement of current plan enrollment. This file uses the same format as the weekly TRR. The file is distributed on or about the first of the month. File includes summary for the beneficiary of accumulated overall totals in PDE amount fields with accumulated totals for covered drugs. Responsible System Type Freq. Dataset Naming Conventions APPS Report As needed APPS APPS MARx PDE Data File As needed Data File Monthly Data File Monthly Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PLNPAYI.Dyymm01.Thh mmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PLNPAYI.Dyymm 01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.PLNPAYI.Dyym m01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PPRID.Dyymmdd.Thhmm sst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PPRID.Dyymmdd. Thhmmsst Connect:Direct (Non-Mainframe): [directory].Rxxxxx.PPRID.Dyymmd d.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.PLAN820D.Dyymm01.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.PLAN820D.Dyym m01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.PLAN820D.Dyy mm01.Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.FEFD.Dyymm01.Thhmms st.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.FEFD.Dyymm01.T hhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.FEFD.Dyymm01. Thhmmsst Gentran Mailbox/TIBCO MFT Internet Server: RPT.DDPS.CUM_BENE_ACT_CO V_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO December 28, 2012 K-13 All Transmissions Overview
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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.23.2 Detail Record (Transaction)
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I.3 Obsolete Transaction Reply Code
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