Medicare Advantage and Prescription Drug Plans December 28 ...

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F.10.2 Detail Record Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Description 1 Record Type 2 1-2 D = Detail Record PIC XX 2 MCO Contract Number 5 3-7 MCO Contract Number PIC X(5) 3 Plan Benefit Package Id 3 8-10 Plan Benefit Package ID PIC X(3) 4 Plan Segment Id 3 11-13 PIC X(3) 5 HIC Number 12 14-25 Member’s HIC # PIC X(12) 6 Surname 7 26-32 PIC X(7) 7 First Initial 1 33 PIC X 8 Sex 1 34 M = Male, F = Female PIC X 9 Date of Birth 8 35-42 YYYYMMDD PIC 9(8) PPO in effect for this Pay Month “SSA” = Withholding by SSA 10 PPO 3 43-45 “RRB” = Withholding by RRB “OPM” = Withholding by OPM PIC X(3) 11 Filler 1 46 Space 12 Premium Period Start Date 8 47-54 Starting Date of Period Premium Payment Covers YYYYMMDD PIC 9(8) 13 Premium Period End Date 8 55-62 Ending Date of Period Premium Payment Covers YYYYMMDD PIC 9(8) Number of Months in Premium 14 Period 2 63-64 PIC 99 Part C Premiums Collected for this Beneficiary, Plan, and premium period. A negative amount indicates a refund by 15 Part C Premiums Collected 8 65-72 withholding agency to Beneficiary of premiums paid in a prior premium period. PIC -9999.99 Part D Premiums Collected (excluding LEP) for this Beneficiary, Plan, and premium period. A negative amount indicates a refund 16 Part D Premiums Collected 8 73-80 by withholding agency to Beneficiary of premiums paid in a prior premium period. PIC -9999.99 17 Part D Late Enrollment Penalties Collected 8 81-88 18 Filler 77 89-165 Spaces Total Length = 165 Part D Late Enrollment Penalties Collected for this Beneficiary, Plan, and premium period. A negative amount indicates a refund by withholding agency to Beneficiary of penalties paid in a prior premium period. PIC -9999.99 December 28, 2012 F-48 MPWR Data File
F.10.3 Trailer Record Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Description 1 Record Type 2 1-2 T1 = Trailer Record, withheld totals at segment level T2 = Trailer Record, withheld totals at PBP level T3 = Trailer record, withheld totals at contract level PIC XX 2 MCO Contract Number 5 3-7 MCO contract number PIC X(5) 3 Plan Benefit Package (PBP) ID 3 8-10 PBP ID, not populated on T3 records PIC X(3) 4 Plan Segment Id 3 11-13 Not populated on T2 or T3 records PIC X(3) 5 Total Part C Premiums Collected 14 14-27 Total withholding collections as specified by Trailer Record type, field (1) PIC -9(10).99 6 Total Part D Premiums Collected 14 28-41 Total withholding collections as specified by Trailer Record type, field (1) PIC -9(10).99 7 Total Part D LEPs Collected 14 42-55 Total withholding collections as specified by Trailer Record type, field (1) PIC -9(10).99 8 Total Premiums Collected 14 56-69 Total Premiums Collected = + Total Part C Premiums Collected + Total Part D Premiums Collected + Total Part D Penalties Collected PIC -9(10).99 9 Filler 96 70-165 Spaces Total Length = 165 December 28, 2012 F-49 MPWR Data File
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Medicare Advantage and Prescription
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Plan Communications User Guide Appe
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F.23.2 Detail Record (Transaction)
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Item # Plan Communications User Gui
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F.28.3 Trailer Record Plan Communic
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I.3 Obsolete Transaction Reply Code
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CMS Transmittals to the Plans Plan
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ID# Transmittal Monthly Transmittal
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Medicare Advantage and Prescription Drug Plans December 28 ...

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