Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 A: Glossary and List of Abbreviations and Acronyms Table A-1: Glossary Term Accepted Transaction Account Number Application Date Batch Transaction Beneficiary Identification Code (BIC) Benefit Stabilization Fund (BSF) Button Cancellation Transaction Checkbox Connect:Direct Correction Cost Plan Current Calendar Month (CCM) Current Processing Month Current Payment Month (CPM) Creditable Coverage Data entry field Deductible Disenrollment Dropdown list Definition The successful application of a requested action that was processed by MARx. A number obtained from the Resource Access Control Facility (RACF) or system administrator. The date that the beneficiary applies to enroll in a Plan. Enrollments submitted by CMS or its contractors, such as the Medicare Beneficiary Contact Center, do not need application dates. An automated systems approach to processing in which data items to be processed must be grouped and processed in bulk. The portion of the Medicare health insurance claim number that identifies a specific beneficiary. Established by CMS upon request of an HMO or CMP, when the HMO or CMP must provide its Medicare enrollees with additional benefits, to prevent excessive fluctuation in the provision of those benefits in subsequent contract periods. A rectangular icon on a screen which, when clicked, engages an action. The button is labeled with word(s) that describe the action, such as Find or Update. A cancellation may result from an action by the beneficiary, CMS, or another Plan before the effective date of the election. A cancelled enrollment restores the beneficiary to his/her prior enrollment state. A field that is part of a group of options, for which the user may select any number of options. Each option is represented with a small box, where ‘x’ means “on” and an empty box means “off.” When a checkbox is clicked, an ‘x’ appears in the box. When the checkbox is clicked again, the ‘x’ is removed. The proprietary software that transfers files between systems. A record submitted by a Plan or CMS office to correct or update existing Beneficiary data. A type of contract under which a Plan is reimbursed by CMS for its reasonable costs. Represents the calendar month and year at the time of transaction submission. For batch, the current month is derived from the batch file transmission date; for User Interface transactions, the current month is derived from the system data at the time of transaction submission. The calendar month in which processing occurs to generate payments. The Current Processing Month is distinguished from the CPM, the month in which Plans receive payment from CMS. The month for which Plans receive payment from CMS, not the current calendar month. Prescription drug coverage, generally from an employer or union, that is equivalent to, or better than, Medicare standard prescription drug coverage. A field that requires the user to enter information. The amount a Beneficiary must pay for medical services or prescription drugs before a Plan starts paying benefits. A record submitted by a Plan, Social Security Administration District Office (SSA DO), Medicare Customer Service Center (MCSC), or CMS when a beneficiary discontinues membership in the Plan. A field that contains a list of values from which the user chooses. Clicking on the down arrow on the right of the field enables the user to view the list of values, and then click on a value to select it. December 28, 2012 A-1 Glossary and List of Abbreviations and Acronyms
Plan Communications User Guide Appendices, Version 6.3 Term Dual Eligible Election Period Enrollment Enrollment Process Exception Failed Payment Reply Codes Failed Transaction Formulary Gentran Hospice Logoff Logon Lookup field Medicaid Managed Care Organization (MCO) Menu Network Data Mover (NDM) MicroStrategy Nursing Home Certifiable (NHC) Off-cycle Definition Individuals entitled to both Medicare and Medicaid benefits Time periods during which a Beneficiary may elect to join, change, or leave Medicare Part C and/or Part D Plans. These periods are fully defined in CMS Enrollment and Disenrollment guidance for Part C and D Plans available on the Web at: http://www.cms.gov/home/medicare.asp under “Eligibility and Enrollment.” A record submitted when a Beneficiary joins an MCO or a drug plan. A process in which a Plan submits a request to enroll in a Plan, change enrollment, or disenroll. A transaction that is unprocessed due to errors or internal inconsistencies. Codes used for the Failed Payment Reply Report that identify incomplete payment calculations for a beneficiary. A transaction that did not complete due to problems with the format of the transaction or internal system problems. The medications covered by an MA organization or prescription drug plan. The Gentran servers provide Electronic Data Interchange (EDI) capabilities between CMS and CMS business partners. These servers provide MARx with transaction files from the Plans, and provide the Plans with MARx reports. A health facility for the terminally ill. The method of exiting an online system. The method for gaining entry to an online system. A field that provides a list of possible values. When the user clicks on the “binocular” button next to the field, a window pops up with a list of values for that field. Clicking on one of those values closes the pop-up window and the field is filled with the value chosen. A jointly funded, Federal-State health insurance program for certain low-income and needy people. It covers approximately 36 million individuals including children, the aged, blind, and/or disabled, and people eligible to receive Federally assisted income maintenance payments. A type of contract under which CMS pays for each member, based on demographic characteristics and health status; also referred to as Risk. In a Risk contract, the MCO accepts the risk if the payment does not cover the cost of services, but keeps the difference if the payment is greater than the cost of services. Risk is managed through a membership where the high costs for very sick members are balanced by the lower cost for a larger number of relatively healthy members. A horizontal list of items at the top of a screen. Clicking on a menu item displays a screen and may display a submenu of items corresponding to the selected menu item. Software used for transmitting and receiving data; replaced by Connect:Direct. A tool used for generating and viewing standard and ad hoc reports. A code that reflects the relative frailty of an individual. NHC Beneficiaries are those whose condition would ordinarily require nursing home care. The code is only acceptable for certain social health maintenance organization (SHMO)- type Plans. A retroactive transaction awaiting CMS approval because its effective date is too old for automatic acceptance. December 28, 2012 A-2 Glossary and List of Abbreviations and Acronyms
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Item # Plan Communications User Gui
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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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