Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Item Field Description 11 Application Date 12 TC 13 Disenrollment Reason 14 Effective Date (YYYYMMDD) 15 Segment ID The application date associated with this enrollment transaction. The application date is generally the date the enrollment request was initially received by the Plan, as further defined in the CMS plan enrollment manual guidance. YYYYMMDD This identifies the type of transaction submitted on this record. 01 = Internal corrections or cleanups 30 = Turn Bene-Level Demonstration Factor On (Demos Only) 31 = Turn Bene-Level Demonstration Factor Off (Demos Only) 41 = Part D Opt-Out Change (Submitted by CMS) 42 = MMP Opt-Out Update 51 = Disenrollment (MCO or CMS) 54 = Disenrollment (Submitted by 1-800-MEDICARE) 61 = Single Enrollment 72 = 4Rx Record Update 73 = NUNCMO Update 74 = Employer Group Health Plan (EGHP) Update 75 = Premium Payment Option (PPO) Update 76 = Residence Address Update 77 = Segment ID Update 78 = Part C Premium Update 79 = Part D Opt-Out Update 80 = Cancellation of Enrollment 81= Cancellation of Disenrollment 82 = MMP Enrollment Cancellation 83 = MMP Opt-Out Update The reason the beneficiary is disenrolled from the Plan. This is required for all Plan submitted Disenrollment transactions. Refer to the published Disenrollment Reason Code (DRC) list and the appropriate CMS plan enrollment manual instructions. The effective date for the action taken by the submitted transaction. YYYYMMDD The three character segment identifier, 001-999 (zero-padded), associated with this transaction. This is only required for segmented Plans. Only local MA/MAPD Plans (Hxxxx) may have segments. For non-segmented plans, this field is populated with blanks. 16 Filler Blank 17 ESRD Override This is populated to enroll an End Stage Renal Disease (ESRD) beneficiary into a non-PDP Plan. Any alpha-numeric value (1-9 and A-F) indicates an override. Zero (0) or blank indicates no override. 18 PPO/ Parts C-D This indicates the premium payment option (PPO) requested by the beneficiary on this transaction. D = Direct self-pay S = Deduct from SSA benefits N = No Premium R = RRB benefits O = Deduct from OPM benefits (future) 19 Part C Premium Amount (XXXXvXX) The option applies to both Part C and D premiums. The amount of the Part C Premium is formatted as six digits with leading zeroes. A decimal point is assumed 2-digits from right; XXXXvXX. Zero is interpreted as an actual value. If Part C premium does not apply to the transaction, this field is treated as blank. December 28, 2012 F-32 MARX Batch Input Transaction Data File
Plan Communications User Guide Appendices, Version 6.3 Item Field Description 20 Filler Blank 21 Creditable Coverage Flag 22 NUNCMO 23 Employer Subsidy Enrollment Override Flag 24 Part D Opt-Out Flag 25 MMP Opt-Out Flag 26 Secondary Drug Insurance Flag This indicates whether the beneficiary has creditable drug coverage in the period prior to this enrollment in a Part D prescription plan. It is also used to reset the count of uncovered months to zero due to a new IEP or LIS change and to remove resets that were set in error. For enrollment (TC 61) transactions, valid values are Y, N, R and blank. For NUNCMO change (TC 73), valid values are Y, N, R, U and blank. Y = the beneficiary has creditable coverage. N = the beneficiary does not have creditable coverage. R = the accumulated NUNCMO is reset to zero as of the effective date on the transaction. U = the previous reset associated with the effective date on the transaction is removed and the total uncovered month accumulation reinstated. The number of months during which the beneficiary did not have creditable coverage in the period prior to this enrollment, as determined by the Plan according to the applicable CMS policy. A NUNCMO is greater than 0 only if the Creditable Coverage Flag is N. This field is populated with zero if the Creditable Coverage Flag is Y, R or U. This flag indicates that the Beneficiary is currently in a Plan receiving an employer subsidy, but still wants to enroll in a Part D Plan. Y = override the employer subsidy check and enroll the beneficiary Blank = No override This flag indicates that the beneficiary does not want AE in a Part D Plan. It applies to LIS beneficiaries who are subject to AE-FE into Part D. Y = add the flag to opt-out of Part D AE-FE. N = remove the flag to opt-out of Part D AE-FE. Blank = no change to opt-out status This flag indicates the beneficiary does not want passive enrollment into an MMP. Y = add the flag to opt-out of passive enrollment into MMPs. N = remove the flag to opt-out of passive enrollment into an MMP. Blank = no change to opt-out status This flag indicates whether that beneficiary has secondary drug insurance. Y = beneficiary has secondary drug insurance N = beneficiary does not have secondary drug insurance blank = status of beneficiary’s secondary drug insurance is unknown 27 Secondary Rx ID 28 Secondary Rx Group Secondary insurance Plan's Identifier for a Beneficiary. It can consist of any combination of alphanumeric characters. Secondary insurance Plan's Group ID for a Beneficiary. It can consist of any combination of alphanumeric characters. December 28, 2012 F-33 MARX Batch Input Transaction Data File
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Medicare Advantage and Prescription
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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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