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) 62 63 64 65 66 Prescription Drug Event (PDE) DBC Cumulative Beneficiary Summary Report Prescription Drug Event (PDE) DBC Cumulative Beneficiary Summary Report Front-End Risk Adjustment System (FERAS) Response Reports Monthly Plan Activity Report Front-End Risk Adjustment System (FERAS) Response Reports Cumulative Plan Activity Report Front-End Risk Adjustment System (FERAS) Response Reports Frequency Report Monthly Report Description File includes summary for the beneficiary of accumulated overall totals in PDE amount fields with accumulated totals for enhanced drugs. File includes summary for the beneficiary of accumulated overall totals in PDE amount fields with accumulated totals for overthe-counter drugs. Report provides monthly summary of the status of submissions by submitter and plan number. Report provides cumulative summary of the status of submissions by Submitter ID and plan number. Report provides monthly summary of all errors on all file submissions within the month. Responsible System Type Freq. Dataset Naming Conventions PDE PDE Data File Monthly Data File Monthly FERAS Report Monthly FERAS Report Monthly FERAS Report Monthly Gentran Mailbox/TIBCO MFT Internet Server: RPT.DDPS_CUM_BENE_ACT_EN H_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO Gentran Mailbox/TIBCO MFT Internet Server: RPT.DDPS_CUM_BENE_ACT_OT C_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO Gentran Mailbox/TIBCO MFT Internet Server: RPT.RAPS_MONTHLY_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO Gentran Mailbox/TIBCO MFT Internet Server: RPT.RAPS_CUMULATIVE_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO Gentran Mailbox/TIBCO MFT Internet Server: RAPS_ERRORFREQ_MNTH_ssssss Connect:Direct: TRANSMITTED FROM PALMETTO Gentran Mailbox/TIBCO MFT Internet Server: 67 LIS/LEP Data File Header Record Detail Record Trailer Record PCUG Record Layout – F.16 This report provides information on low-income subsidized Beneficiaries and on direct-billed Beneficiaries with late enrollment penalties. Note: The date in the file name defaults to “01” denoting the first day of the current payment month. MARx Data File Monthly P.Fxxxxx.LISLEPD.Dyymm01.Thh mmsst.pn P.Rxxxxx.LISLEPD.Dyymm01.Thh mmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Fxxxxx.LISLEPD.Dyymm0 1.Thhmmsst zzzzzzzz.Rxxxxx.LISLEPD.Dyymm 01.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Fxxxxx.LISLEPD.Dyymm 01.Thhmmsst [directory]Rxxxxx.LISLEPD.Dyymm 01.Thhmmsst December 28, 2012 K-14 All Transmissions Overview
Plan Communications User Guide Appendices, Version 6.3 ID# Transmittal Monthly Transmittals (Data & Reports) 68 LIS History Data File (LISHIST) PCUG Record Layout – F.19 Description This file supplements existing files that provide LIS notifications. It provides a complete picture of a beneficiary’s LIS eligibility over a period of time not to exceed 36 months. Note: The date in the file name defaults to “dd” denoting the day of the calendar month Responsible System Type Freq. Dataset Naming Conventions MARx Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.LISHIST.Dyymmdd.Thhm msst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.LISHIST.Dyymmd d.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rxxxxx.LISHIST.Dyymm dd.Thhmmsst 69 Agent Broker Compensation Data File PCUG Record Layout – F.27 This data file provides sixyear broker compensation cycle-year counts. Data is sent to Plans 1) when a beneficiary enrolls, 2) each January when the cycleyear count increments and 3) as necessary when retroactive change affects the compensation cycle. Plans may re-order the 6- year Broker Compensation Report Data File” via the UI. MARx Data File Monthly, generally with the first weekly TRR of the month Gentran Mailbox/TIBCO MFT Internet Server: P.Rnnnnn.COMPRPT.Dyymmdd.Th hmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rnnnnn.COMPRPT.Dyym mdd.Thhmmsst Connect:Direct (Non-Mainframe): [directory]Rnnnnn.COMPRPT.Dyym mdd.Thhmmsst 70 Monthly MSP Information Data File PCUG Record Layout – F.28 This data file is sent directly to Plans on the first Monday after the MARx month-end processing completes. This file contains a subset of information to allow Plans to reconcile payment; the full monthly MSP COB file distributed at the beginning of each month contains more detail. MDB Data File Monthly Gentran Mailbox/TIBCO MFT Internet Server: P.Rxxxxx.MSPCOBAD.Dyymmdd.T hhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.MSPCOBAD.Dyy mmdd.Thhmmsst Connect:Direct (Non-Mainframe): [directory].Rxxxxx.MSPCOBAD.Dy ymmdd.Thhmmsst 71 Other Health Coverage Information Data File PCUG Record Layout – F.29 CMS provides Plans with a file listing the Beneficiaries who are enrolled in their plan(s) where Medicare is listed secondary. As a monthly report, this vehicle provides Plans with regular updates to the MSP data. MDB Data File Monthly Gentran: P.Rxxxxx.MSPCOBMA.Dyymmdd. Thhmmsst.pn Connect:Direct (Mainframe): zzzzzzzz.Rxxxxx.MSPCOBMA.Dyy mmdd.Thhmmsst Connect:Direct (Non-Mainframe): [directory].Rxxxxx.MSPCOBMA.Dy ymmdd.Thhmmsst December 28, 2012 K-15 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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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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