Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Table of Contents A: Glossary and List of Abbreviations and Acronyms ......................................................... A-1 A.1 List of Abbreviations and Acronyms .................................................................................. A-4 B: CMS Central Office Contact Information ..........................................................................B-1 B.1 CMS Central Office ..............................................................................................................B-2 B.2 Payment Information Form ...................................................................................................B-2 C: Monthly Schedule ................................................................................................................ C-1 D: Enrollment Data Transmission Schedule .......................................................................... D-1 E: ESRD Network Contact Information Table .......................................................................E-1 F: Record Layouts...................................................................................................................... F-1 DTRR Data File Detailed Record Layout ..................................................................... F-1 F.1 820 Format Payment Advice Data File ................................................................................. F-3 F.1.1 Header Record ...................................................................................................... F-4 F.1.2 Detail Record ........................................................................................................ F-5 F.1.3 Trailer Record ...................................................................................................... F-6 F.2 Batch Completion Status Summary Data File ....................................................................... F-7 F.2.1 Failed Record ....................................................................................................... F-7 F.2.2 BCSS ‘Failed Transaction’ Layout ...................................................................... F-8 F.3 BIPA 606 Payment Reduction Data File .............................................................................. F-9 F.4 Bonus Payment Data File ................................................................................................... F-10 F.5 Coordination of Benefits (COB); Validated Other Health Insurance Data File .................. F-11 F.5.1 General Organization of Records ....................................................................... F-11 F.5.2 Detail Records: Indicates the Beginning of a Series of Beneficiary Subordinate Detail Records ........................................................................ F-11 F.5.3 Primary Records: Subordinate to Detail Record (Unlimited Occurrences) ....... F-12 F.5.4 Supplemental Records: Subordinate to DTL (Unlimited Occurrences) ............. F-15 F.6 MARX Batch Input Transaction Data File .......................................................................... F-18 F.6.1 Header Record .................................................................................................... F-18 F.6.2 Disenrollment Transaction (TC 51/54) Detailed Record Layout ....................... F-19 F.6.3 Enrollment Transaction (TC 61) Detailed Record Layout ................................. F-20 F.6.4 Miscellaneous Change Transactions – Detailed Record Layouts ...................... F-22 F.6.5 Cancellation Transactions – Detailed Record Layouts ...................................... F-28 F.6.6 Correction Record .............................................................................................. F-30 F.6.7 Notes for All Plan-Submitted Transaction Types .............................................. F-31 F.7 Failed Transaction Data File - OBSOLETE ........................................................................ F-35 F.8 Monthly Membership Detail Data File ................................................................................ F-36 December 28, 2012 v Table of Contents
Plan Communications User Guide Appendices, Version 6.3 F.9 Monthly Membership Summary Data File .......................................................................... F-44 F.10 Monthly Premium Withholding Report Data File (MPWR) ............................................. F-47 F.10.1 Header Record .................................................................................................. F-47 F.10.2 Detail Record .................................................................................................... F-48 F.10.3 Trailer Record .................................................................................................. F-49 F.11 Part B Claims Data File ..................................................................................................... F-50 F.11.1 Record Type 1 .................................................................................................. F-50 F.11.2 Record Type 2 .................................................................................................. F-51 F.12 Part C Risk Adjustment Model Output Data File .............................................................. F-52 F.12.1 Header Record .................................................................................................. F-52 F.12.2 Detail Record Type A ...................................................................................... F-52 F.12.3 Detail Record Type B ....................................................................................... F-60 F.12.4 Trailer Record .................................................................................................. F-70 F.13 Risk Adjustment System (RAS) Prescription Drug Hierarchical Condition Category (RxHCC) Model Output Data File - aka Part D RA Model Output Data File ............ F-71 F.13.1 Header Record .................................................................................................. F-71 F.13.2 Detail/Beneficiary Record ................................................................................ F-71 F.13.3 Trailer Record .................................................................................................. F-80 F.14 Daily Transaction Reply Report (DTRR) Data File .......................................................... F-81 F.14.1 DTRR Data File Detailed Record Layout ........................................................ F-81 F.14.2 Verbatim Plan Submitted Transaction on Daily Transaction Reply Report (DTRR) ....................................................................................................... F-89 F.15 Monthly Full Enrollment Data File ................................................................................... F-90 F.16 LIS/LEP Data File ............................................................................................................. F-92 F.16.1 Header Record .................................................................................................. F-92 F.16.2 Detail Record .................................................................................................... F-92 F.17 Loss of Subsidy Data File .................................................................................................. F-95 F.17.1 Loss of Subsidy Data File Detail Record ......................................................... F-95 F.18 LIS/Part D Premium Data File .......................................................................................... F-97 F.19 LIS History Data File (LISHIST) ...................................................................................... F-98 F.19.1 Header Record .................................................................................................. F-98 F.19.2 Detail Record (Transaction) ............................................................................. F-99 F.19.3 Trailer Record ................................................................................................ F-101 F.20 NoRx File......................................................................................................................... F-102 F.20.1 Header Record ................................................................................................ F-102 F.20.2 Detail Record .................................................................................................. F-103 F.20.3 Trailer Record ................................................................................................ F-105 F.21 Batch Eligibility Query (BEQ) Request File ................................................................... F-106 F.21.1 Header Record ................................................................................................ F-106 F.21.2 Detail Record (Transaction) ........................................................................... F-107 F.21.3 Trailer Record ................................................................................................ F-108 December 28, 2012 vi Table of Contents
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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.23.2 Detail Record (Transaction)
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Item # Plan Communications User Gui
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F.28.3 Trailer Record Plan Communic
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I.3 Obsolete Transaction Reply Code
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CMS Transmittals to the Plans Plan
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ID# Transmittal Monthly Transmittal
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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