Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Format Valid Values/Description 13 Supplemental Type Code 1 111 CHAR L=Supplemental M=Medigap N=State Program (Non-Qualified SPAP) O=Other P=Patient Assistance Program Q=Qualified State Pharmaceutical Assistance Program (SPAP) R=Charity S=AIDS Drug Assistance Program T=Federal Health Program 1=Medicaid 2=Tricare 3 = Major Medical 14 15 16 17 Coverage Code* Insurer's Name* Insurer's Address-1* Insurer's Address-2* 1 112 CHAR 32 113-144 CHAR 32 145-176 CHAR 32 177-208 CHAR 18 Insurer's City* 15 209-223 CHAR U=Drug (network benefit) V=Drug with Major Medical (non-network benefit) 19 Insurer's State* 2 224-225 CHAR 20 Insurer's Zip Code* 9 226-234 CHAR 21 Filler 10 235-244 CHAR Spaces 22 23 Individual Policy Number* Group Policy Number* 17 245-261 CHAR 20 262-281 CHAR 24 Effective Date* 8 282-289 ZD CCYYMMDD 25 Termination Date* 8 290-297 ZD CCYYMMDD 26 Relationship Code* 2 298-299 CHAR 01=Bene is Policy Holder 02=Spouse 03=Child 04=Other 27 Payer ID* 10 300-309 CHAR December 28, 2012 F-16 COB; Validated Other Health Insurance Data
Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Format Valid Values/Description 28 Person Code* 3 310-312 CHAR 29 Payer Order* 3 313-315 ZD 30 Filler 685 316-1000 SPACES Total Length = 1,000 *Indicates that these fields have same position in PRM and SUP record layouts December 28, 2012 F-17 COB; Validated Other Health Insurance Data
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Plan Communications User Guide Appe
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Item # Plan Communications User Gui
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I.3 Obsolete Transaction Reply Code
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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