Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
Item Fields Size Position Description
27 Secondary Rx ID 20 136-155
28 Secondary Rx Group 15 156-170
29 Enrollment Source 1 171
30 Filler 38 172-209 N/A
31
Plan Assigned Transaction
Tracking ID
15 210-224 Optional
32 Part D Rx BIN 6 225-230
33 Part D Rx PCN 10 231-240
34 Part D Rx Group 15 241-255
35 Part D Rx ID 20 256-275
36 Secondary Drug BIN 6 276-281
37 Secondary Drug PCN 10 282-291
38 Filler 9 292-300 N/A
Total Length = 300
rollovers, value is blank. For non-Part D Plans,
value is blank.
Required: if secondary insurance; otherwise,
blank.
Required: if secondary insurance; otherwise,
blank.
Required: for Point of Service (POS) submitted
enrollment transactions; otherwise, optional.
Required: for all Part D Plans except PACE
National and MMP; otherwise, blank.
Change-to value for all Part D Plans, otherwise
blank.
Change-to value for all Part D Plans, otherwise
blank.
Required: for all Part D Plans except PACE
National and MMP; otherwise, blank.
Required: if secondary insurance; otherwise,
blank.
Required: if secondary insurance; otherwise,
blank.
*The “51” transaction is Plan submitted. The “54” is submitted by 1-800-Medicare without a
header record.
**Plan Transaction Tracking ID field is not used by 1-800-Medicare.
Note: Election type rules do apply to HCPP, COST 1 without drug, COST 2 without drug,
CCIP/FFS demos, MDHO demo, MSHO demo and PACE National enrollments in cases where
such an enrollment would causes an automatic disenrollment from another plan requiring an
election type. It is important that the election type for the Plan on the enrollment request is
consistent with the election type required for automatic disenrollment.
Note: MA organizations and cost plans that auto/facilitate enroll LIS Beneficiaries on behalf of
CMS should use the appropriate newly-designated enrollment source code when submitting autoenrollments
or facilitated enrollments: E = Plan-submitted auto-enrollment, F = Plan-submitted
facilitated enrollment, G = Point-of-Sale (POS) submitted enrollment; for use by POS contractor
only, H = CMS reassignment enrollment, I = Assigned to Plan-submitted enrollment with
enrollment source other than any of the following: B, E, F, G, H and blank.
December 28, 2012 F-21 MARX Batch Input
Transaction Data File