Medicare Advantage and Prescription Drug Plans December 28 ...

Plan Communications User Guide Appendices, Version 6.3
I.3 Obsolete Transaction Reply Codes .............................................................................. I-84
I.4 Transaction Reply Code (TRC) Groupings .................................................................. I-91
I.5 Payment Reply Codes ................................................................................................. I-100
I.6 MMR Adjustment Reason Codes ............................................................................... I-101
I.7 State Codes ................................................................................................................. I-103
I.8 Entitlement Status and Enrollment Reason Codes ..................................................... I-105
I.9 Disenrollment Reason Codes ..................................................................................... I-108
I.10 BEQ Response File Error Condition Table ................................................................ I-111
I.10.1 Request File Error Conditions .......................................................................... I-111
I.10.2 Request Transaction Detail Record Error Conditions ...................................... I-112
J: Report Files ............................................................................................................................ J-1
J.1 BIPA 606 Payment Reduction Report..................................................................................... J-2
J.2 Bonus Payment Report ............................................................................................................ J-6
J.3 HMO Bill Itemization Report................................................................................................ J-11
J.4 Monthly Membership Detail Report – Drug Report (Part D) ............................................... J-12
J.5 Monthly Membership Detail Report – Non-Drug Report (Part C) ....................................... J-13
J.6 Monthly Membership Summary Report (MMSR) ................................................................ J-15
J.7 Monthly Summary of Bills Report ........................................................................................ J-19
J.8 Part C Risk Adjustment Model Output Report ..................................................................... J-21
J.9 RAS RxHCC Model Output Report - aka - Part D RA Model Output Report ..................... J-22
J.10 Payment Records Report ........................................................................................................23
J.11 Plan Payment Report (APPS Payment Letter) .......................................................................24
J.12 Interim Plan Payment Report (IPPR) .................................................................................. J-29
J.13 No Premium Due Report Format ........................................................................................ J-30
J.14 Sample BEQ Request File Pass and Fail Acknowledgments .............................................. J-36
K: All Transmissions Overview ............................................................................................... K-1
L: MA Plan Connectivity Checklist .........................................................................................L-1
M: Valid Election Types for Plan-Submitted Transactions ................................................. M-1
December 28, 2012 viii Table of Contents