Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
F.6.5.4 MMP Opt-Out Update (TC 83) Layout
Item Field Size Position Description
1 HICN 12 1-12 Required
2 Surname 12 13-24 Required
3 First Name 7 25-31 Required
4 M. Initial 1 32 Optional
5 Gender Code 1 33 Required
6 Birth Date (YYYYMMDD) 8 34-41 Required
7 Filler 1 42 N/A
8 PBP # 3 43-45 Required
9 Filler 1 46 N/A
10 Contract # 5 47-51 Required
11 Filler 8 52-59 N/A
12 TC 2 60-61 Required
13 Filler 2 62-63 N/A
14 Effective Date (YYYYMMDD) 8 64-71 Required
15 Filler 28 72-99 N/A
16 MMP Opt-Out Flag 1 100 Required
17 Filler 109 101-209 N/A
18 Plan Transaction Tracking ID 15 210-224 Optional
19 Filler 76 225-300 N/A
Total Length = 300
F.6.6 Correction Record
Note: The effective date for ‘01’ transactions comes from the file header.
Item Field Size Position Correction Description
1 HICN 12 1-12 R
Nine-byte SSN of primary Beneficiary Claim Account
Number (CAN); two-byte Beneficiary Identification Code
(BIC) one-byte filler (except RRB)
-2 Surname 12 13-24 R Beneficiary’s last name
3 First Name 7 25-31 R Beneficiary’s first name
4 M. Initial 1 32 Beneficiary’s middle initial
D = Institutional ON
E = Medicaid ON
5 Action Code 1 33 R
F = Medicaid OFF
G = Nursing Home Certifiable (NHC) ON
6 Filler 13 34-41 N/A Spaces
7 Contract # 5 47-51 R Contract Number
8 Filler 8 52-59 N/A Spaces
Transaction
9
Code (TC)
2 60-61 R ‘01’ = Correction
10 Filler 239 62-300 N/A Spaces
Total Length = 300
December 28, 2012 F-30 MARX Batch Input
Transaction Data File