Medicare Advantage and Prescription Drug Plans December 28 ...

More documents

Recommendations

Info

Plan Communications User Guide Appendices, Version 6.3 F.9 Monthly Membership Summary Data File This is a data file version of the Monthly Membership Summary Report (MMSR) for both Part C and Part D members, summarizing payments made to a Plan for the month, in several categories; and the adjustments, by all adjustment categories. Item Field Size Position Description 1 MCO Contract Number 5 1-5 MCO Contract Number 2 Run Date of the File 8 6-13 YYYYMMDD 3 Payment Date 6 14-19 YYYYMM 4 Adjustment Reason Code 2 20-21 Adjustment Reason Code 5 Record Description 10 22-31 Description of the record: TOTAL PAYM ESRD HOSPICE MCAID OTHER WA OUTOFAREA DIR SUBSDY LIS CSTSHR EST REINS PACE PRM PACE CSHR PTC PREM RBT AB CSR RBT AB MSB RBT D PRRE RBT D SUBE PTB PRM RE B PRM RE A B PRM RE D BSF MNTHLY AD MSP COV GAP TOTAL ADJ HOSPIC ON HOSPIC OFF ESRD ON ESRD OFF INST ON INST OF MCAID ON MCAID OFF WKAGE ON WKAGE OFF NHC ON NHC OFF DEATH RETRO ENRO RETRO DISEN CORR PARTA RETRO SCC C CORR DEATH December 28, 2012 F-44 Monthly Membership Summary Data File
Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Description CORR BIRTH CORR SEX PTC RATE CORR PARTB DISENROLL P DEMO FACTO PTC RSK AD PTCRAF MID RETRO CHF HOSPICE RAT RTRO PTC P RTRO PTD L RTRO CST S RTRO EST R RTRO PTC R RTRO REBAT PTD RATE C PTD RAF SEG ID CHG PTDRAF MID RETRO MSP PLN SUB PREM ESRD MSP LIPS XRF MRG PYMT CORR CLNUP ADJ 6 Payment Adjustment Count 7 32-38 Beneficiary Count 7 Month count 7 39-45 For payment record it is Beneficiary Count, but for adjustment record it is spaces. 8 Part A Member count 7 46-52 For payment records, Beneficiary count for Part A; for adjustment records, spaces. 9 Part A Month count 7 53-59 For payment record Beneficiary count for Part A , but for adjustment record it is the number of months adjusted for Part A. 10 Part B Member count 7 60-66 For payment record Beneficiary count for Part B; for 11 Part B Month count 7 67-73 12 13 Part A Payment/Adjustment Amount Part B Payment/Adjustment 13 74-86 PART A Amount 13 87-99 PART B Amount adjustment records, spaces. For payment record Beneficiary count for Part B but for adjustment record it is the number of months adjusted for Part B. Amount 14 Total Amount 13 100-112 Total Payment/Adjustment Amount 15 Part A Average 9 113-121 Average Part A Amount per Part A Member 16 Part B Average 9 122-130 Average Part B Amount per Part B Member 17 Payment/Adjustment Indicator 1 131-131 ‘P’ for Payments and ‘A’ for Adjustments 18 PBP Number 3 132-134 Plan Benefit Package Number 19 Segment Number 3 135-137 Segment Number December 28, 2012 F-45 Monthly Membership Summary 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:
Page 21 and 22: Plan Communications User Guide Appe
Page 71: 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 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?