Medicare Advantage and Prescription Drug Plans December 28 ...

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Plan Communications User Guide Appendices, Version 6.3 Item Field Size Position Comment Description 154 SEPSIS_ ASP_SPEC_ BACT_ PNEUM 155 SEPSIS_ PRESSURE_ ULCER 1 197 Set to "1" if applicable SEPSIS_ASP_SPEC_BACT_ PNEUM 1 198 Set to "1" if applicable SEPSIS_PRESSURE_ULCER 156 Filler 1 199 - 200 Spaces Filler Total Length = 200. NOTE: Fields 140-155 are associated with the CMS HCC V21 Institutional Score only. F.12.4 Trailer Record Item Field Size Position Comment Description 1 Record Type 1 1 Set to "3" 1 = Header A = Details for old V12 PTC MOR B = Details for new V21 PTC MOR 3 = Trailer 2 3 Contract Number Total Record Count 5 2-6 9 7-15 Also known as MCO Plan number Includes all header and trailer records 4 Filler 185 16-200 Spaces Filler Total Length = 200 Unique identification for a Managed Care Organization (MCO) enabling the MCO to provide coverage to eligible beneficiaries Record count in display format December 28, 2012 F-70 Part C Risk Adjustment Model Output Data File
Plan Communications User Guide Appendices, Version 6.3 F.13 Risk Adjustment System (RAS) Prescription Drug Hierarchical Condition Category (RxHCC) Model Output Data File - aka Part D RA Model Output Data File The following records are included in this file: Header Record Detail/Beneficiary Record Format Trailer Record F.13.1 Header Record The Contract Header Record signals the beginning of the detail/Beneficiary records for a Medicare Advantage or stand-alone PDP contract. Item Field Size Position Comment Description 1 2 Record Type Code Contract Number 1 1 Set to "1" 5 2-6 3 Run Date 8 7-14 4 Payment Year and Month 6 15-20 Also known as MCO plan number Format as yyyymmdd Format as yyyymm 5 Filler 148 21-168 Spaces Filler Total Length = 168 1 = Header 2 = Details 3 = Trailer Unique identification for a Managed Care Organization (MCO) enabling the MCO to provide coverage to eligible beneficiaries. The run date when this file was created. This identifies the risk adjustment payment year and month for the model run. F.13.2 Detail/Beneficiary Record Each Detail/Beneficiary Record contains information for an HCC beneficiary in a Medicare Prescription Drug contract/plan, as of the last RAS model run for the current calendar/payment year. December 28, 2012 F-71 RAS RxHCC Model Output Data File
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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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