Medicare Advantage and Prescription Drug Plans December 28 ...

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