Medicare Advantage and Prescription Drug Plans December 28 ...

More documents

Recommendations

Info

Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Description Part D Long-Term The member’s Part D institutional multiplier. NN.DDDD 71 Institutional 7 326-332 For 2011 payment months and beyond, field is zero. Multiplier 72 73 74 Rebate for Part D Basic Premium Reduction Part D Basic Premium Amount Part D Direct Subsidy Monthly Payment Amount 8 333-340 Amount of the rebate allocated to reducing the member’s basic Part D premium. -9999.99 8 341-348 The Plan’s Part D premium amount. -9999.99 10 349-358 The total Part D Direct subsidy payment for the member. When POS contract (X is first character of contract number), then it is total POS Direct Subsidy for the member. - 999999.99 The amount of the reinsurance subsidy included in the payment. -999999.99 The amount of the low-income subsidy cost-sharing amount included in the payment. -999999.99 75 Reinsurance Subsidy Amount 10 359-368 76 Low-Income Subsidy Cost-Sharing Amount 10 369-378 77 Total Part D Payment 11 379-389 The total Part D payment for the member -9999999.99 Number of 78 Paymt/Adjustmt 2 390-391 99 Months Part D 79 80 81 PACE Premium Add On PACE Cost Sharing Add-on Part C Frailty Score Factor 10 392-401 Total Part D Pace Premium Add-on amount -999999.99 10 402-411 Total Part D Pace Cost Sharing Add-on amount -999999.99 7 412-418 82 MSP Factor 7 419-425 83 84 85 MSP Reduction/Reduction Adjustment Amount – Part A MSP Reduction/Reduction Adjustment Amount – Part B Medicaid Dual Status Code 10 426-435 10 436-445 2 446-447 Beneficiary’s Part C frailty score factor, NN.DDDD; otherwise, spaces Beneficiary’s MSP secondary payor reduction factor, NN.DDDD; otherwise, spaces Net MSP reduction or reduction adjustment dollar amount– Part A, SSSSSS9.99 Net MSP reduction or reduction adjustment dollar amount – Part B, SSSSSS9.99 Entitlement status for the dual eligible beneficiary. The valid values when Field 40 = 1 are: 01 = Eligible is entitled to Medicare- QMB only 02 = Eligible is entitled to Medicare- QMB AND Medicaid coverage 03 = Eligible is entitled to Medicare- SLMB only 04 = Eligible is entitled to Medicare- SLMB AND Medicaid coverage 05 = Eligible is entitled to Medicare- QDWI 06 = Eligible is entitled to Medicare- Qualifying individuals 08 = Eligible is entitled to Medicare- Other Dual Eligibles (Non QMB, SLMB,QDWI or QI) with Medicaid coverage 09 = Eligible is entitled to Medicare – Other Dual Eligibles but without Medicaid coverage 99=Unknown The valid value when Field 40 = 0 is: 00 = No Medicaid Status The valid value when Field 40 is blank is: Blank December 28, 2012 F-42 Monthly Membership Detail Data File
Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Description Part D Coverage Gap The amount of the Coverage Gap Discount Amount included 86 8 448-455 Discount Amount in the payment. -9999.99 Beginning with January 2011 payment, factors in use (see Field 67): D1 = Community Non-Low Income Continuing Enrollee, D2 = Community Low Income Continuing Enrollee, D3 = Institutional Continuing Enrollee, D4 = New Enrollee Community Non-Low Income Non- Part D RA Factor 87 2 456-457 ESRD, Type D5 = New Enrollee Community Non-Low Income ESRD, D6 = New Enrollee Community Low Income Non-ESRD, D7 = New Enrollee Community Low Income ESRD, D8 = New Enrollee Institutional Non-ESRD, D9 = New Enrollee Institutional ESRD, Blank when it does not apply. 88 89 90 91 Default Part D Risk Factor Code Part A Risk Adjusted Monthly Rate Amount for Pymt/Adj Part B Risk Adjusted Monthly Rate Amount for Pymt/Adj Part D Direct Subsidy Monthly Rate Amount for Pymt/Adj 1 458 9 459-467 9 468-476 9 477-485 92 Cleanup ID 10 486-495 Total Length = 495 Beginning with January 2011 payment : 1=Not ESRD, Not Low Income, Not Originally Disabled, 2=Not ESRD, Not Low Income, Originally Disabled, 3=Not ESRD, Low Income, Not Originally Disabled, 4=Not ESRD, Low Income, Originally Disabled, 5= ESRD, Not Low Income, Not Originally Disabled, 6= ESRD, Low Income, Not Originally Disabled, 7= ESRD, Not Low Income, Originally Disabled, 8= ESRD, Low Income, Originally Disabled, Blank when it does not apply. Beginning August 2011: Payments = Rate amount in effect for payment period Adjustments = Rate amount in effect for adjustment period Format: -99999.99 Beginning August 2011: Payments = Rate amount in effect for payment period Adjustments = Rate amount in effect for adjustment period Format: -99999.99 Beginning August 2011: Payments = Rate amount in effect for payment period Adjustments = Rate amount in effect for adjustment period Format: -99999.99 Cleanup Identifier, a reference linking to further documentation about a specific cleanup. December 28, 2012 F-43 Monthly Membership Detail Data File
Page 1 and 2:
Medicare Advantage and Prescription
Page 3 and 4:
Plan Communications User Guide Appe
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20: Plan Communications User Guide Appe
Page 69: Plan Communications User Guide Appe
Page 77 and 78: F.10.3 Trailer Record Plan Communic
Page 79 and 80: F.11.2 Record Type 2 Plan Communica
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
F.21.2 Detail Record (Transaction)
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
F.23.2 Detail Record (Transaction)
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Item # Plan Communications User Gui
Page 171 and 172:
F.28.3 Trailer Record Plan Communic
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
I.3 Obsolete Transaction Reply Code
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
CMS Transmittals to the Plans Plan
Page 343 and 344:
Page 345 and 346:
ID# Transmittal Monthly Transmittal
Page 347 and 348:
ID# Transmittal Monthly Transmittal
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
show all

Medicare Advantage and Prescription Drug Plans December 28 ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?