LayoutWeeklyMonthlyTRRDataFile 032606

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1 Description neficiary Entitlement Type Code Beneficiary Given Name Be YYYYMMDD Format 1 = End-Stage Renal Disease 1 = Disabled 1 = Medicaid 0 = No Medicaid 0 = Unknown 0 = No End-Stage Renal Disease 2 = Female 1 = Male 0 = No Disability 0 = No Hospice Beneficiary Residence State Code Beneficiary Residence County Code 0 = No Institutional 2 = NHC 1 = Hospice Claim Account Number Beneficiary Surname Beneficiary Middle Initial Beneficiary Sex Identification Code Transaction Reply Code 1 = Institutional Transaction Type Code 47 Plan Contract Number 1 of 7 62 03/26/06 56 53 42 32 54 33 55 1 – 12 25 – 31 34 – 41 43 – 48 – 49 50 – 52 57 – 59 60 – 61 13 – 24 Position 7 1 8 5 1 1 1 1 2 3 1 1 2 3 1 12 12 Size Weekly/Monthly Transaction Reply Field Indicator Code Code 11. Disability Indicator 10. County Code 8. Contract Number 15. Transaction Reply 9. State Code 7. Medicaid Indicator 6. Date of Birth 13. Institutional/NHC 16. Transaction Type 14. ESRD Indicator 4. Middle Name 3. First Name 2. Surname 17. Entitlement Type Code 1. Claim Number 12. Hospice Indicator 5. Sex Code

2 and 12 21 Deleted: Deleted: Deleted: , 83 38, 17, , 116, 122, 112 , 109 146, 148, 150, 162, 163, 128, 129, 130, 131, 133, 110, 111, 025, 026, 040, 062, 075, Description 23, 22, 14, 18, 84 YYYYMMDD Format; Present only when the Space Spaces 1 = Working Aged Transaction Reply Code is one of the following: 11, , 16, 17, 0 = No Working Aged reply codes 100 52, 80, 82 – 84, 100, 164, 170, 171, 172, 173 134, 139, 140, 141, 143, 123, 124, 125, 126, 127, 35, 71 Present only when Transaction Reply Code is one of the following: 22, 25, 86 13, Transaction Reply Code is one of the following: YYYYMMDD Format; Present only when Transaction Reply Code is one of the following: YYYYMMDD Format; Present only when Transaction Reply Code is the following: YYYYMMDD Format; Present only when YYYYMMDD Format; Present only when Transaction Reply Code is one of the following: 36, 90, 91, 92 YYYYMMDD Format; Present for all transaction PBP number 2 of 7 75 84 03/26/06 71 63 – 70 85 – 92 76 – 83 85 – 96 85 – 92 85 – 92 85 – 92 72 – 74 Position 1 1 8 8 1 8 8 8 8 3 12 Size Weekly/Monthly Transaction Reply Field Date (new) Date e. Hospice Start c. Claim Number a. Disenrollment b. Enrollment Date d. Date of Death all codes except where indicated below. ID 21. Filler 23. Filler 20. Plan Benefit Package 19. WA Indicator 18. Effective Date 22. Transaction Date 24. Positions 85 – 96 are dependent upon the value of the TRANSACTION REPLY CODE. There are spaces for

3 Description , 158,159 YYYYMMDD Format; Present only when YYYYMMDD Format; Present only when YYYYMMDD Format; Present only when YYYYMMDD Format; Present only when Transaction Reply Code is the following: 78 Transaction Reply Code is the following: 82 YYYYMMDD Format; Present only when 49, 76 YYYYMMDD Format; Present only when Transaction Reply Code is one of the following: 48, 75 Transaction Reply Code is the following: 77 Transaction Reply Code is the following: 80 Transaction Reply Code is one of the following: 45, 73 YYYYMMDD Format; Present only when Transaction Reply Code is the following: 79 YYYYMMDD Format; Present only when YYYYMMDD Format; Present only when Transaction Reply Code is the following: 74 YYYYMMDD Format; Present only when Present only when Transaction Reply Code is the Transaction Reply Code is the following: 81 following: 85 Transaction Reply Code is the following: 72 Transaction Reply Code is the following: 67 YYYYMMDD Format; Present only when Transaction Reply Code is the following: 66 YYYYMMDD Format; Present only when Transaction Reply Code is one of the following: YYYYMMDD Format; Present only when Beneficiary Residence State and County Code; 3 of 7 03/26/06 85 – 92 85 – 92 85 – 92 85 – 92 85 – 92 85 – 92 85 – 92 85 – 89 85 – 92 85 – 92 85 – 92 85 – 92 85 – 92 85 – 92 Position 8 8 8 8 8 8 5 8 8 8 8 8 8 8 Size Weekly/Monthly Transaction Reply Field Date NHC End Date NHC Start Date Date Date Date m. Part A End Date f. Hospice End Date r. Part B Reinstate p. Part A Reinstate g. ESRD Start Date h. ESRD End Date n. WA Start Date q. Part B End Date s. SCC i. Institutional/ l. Medicaid End k. Medicaid Start j. Institutional/ o. WA End Date

4 Code of the originating district District Office Code Type Code is 53 Deleted: office; Present only when Transaction Deleted: t only when transaction Description Spaces file, this field is now fill space. Further definition of PBP by geographic Part B Payments are no longer part of the TR data Part A Payments are no longer part of the TR data MMCS Data file ended with position 133. Note: This field was previously filler in MMCS (paper). Format: YYYYMMDD beneficiary signed the enrollment application completed enrollment (electronic) or the date the boundaries The date the plan received the beneficiary’s file, this field is now fill space. Transaction Reply Code is the following: 168 YYYYMMDD Format; Present only when YYYYMMDD Format; Present only when Transaction Reply Code is the following: 167 Spaces Prior PBP number; presen type code is 71 Out of Area Indicator Cost to beneficiary for Part D benefits Transaction Source Identifier Cost to beneficiary for Part C benefits 4 of 7 – 134 03/26/06 85 – 92 85 – 92 97 – 99 Position 124 – 131 100 – 107 108 – 115 132 – 133 134 135 – 137 146 – 153 121 – 123 138 – 145 116 – 120 8 8 8 2 1 3 8 3 8 8 8 3 5 Size Weekly/Monthly Transaction Reply Field Change Date Change Date Premium Subsidy Sharing Subsidy u. Low-Income Cost t. Low-Income Premium Filler Package ID 26. Filler MMA fields start here: 31. Filler 35. Part D Beneficiary Premium 25. 33. Segment Number 30. Application Date 32. Out of Area Flag 28. Source ID 27. Filler 34. Part C Beneficiary 29. Prior Plan Benefit

5 number for beneficiary Description P; E = IEP; I = ICEP; S=SEP; A = AE A = Auto enrolled by CMS now fill space. longer part of the TR data file, this field is now fill Part D plan’s Rx ID number for beneficiary is no Part D plan’s Rx group ID is no longer part of the TR data file, this field is O = OEP; N = OEPNEW; T = OEPI MA/MA-PDs have I, A, O, S, N, T PDPs have E, A, and S space. B = Beneficiary Election C = Facilitated enrollment by CMS D = CMS Annual Rollover Blank = No change to opt-out status R = Deduct from RRB benefits subsidy, flag allows enrollment in a Part D plan. Y = Beneficiary is in a plan receiving an employer N = Not Covered N = No premium applicable O = Deduct from OPM benefits S = Deduct from SSA benefits Option applies to both Part C and D Premiums Y = Covered D = Direct self-pay Y = Opt-out of auto enrollment Count of Total Months without drug coverage 5 of 7 03/26/06 Position 155 – 155 154 – 154 183 – 197 163 – 182 156 – 156 162 – 162 161 – 161 157 – 157 158 – 160 1 1 1 1 3 1 1 20 15 Size Weekly/Monthly Transaction Reply Field Override Flag Flag Months Option/Parts C-D 44. Filler 41. Creditable Coverage 43. Filler 39. Premium Withhold 40. Number of Uncovered 38. Part D Opt-Out Flag 37. Enrollment Source 36. Election Type 42. Employer Subsidy

6 Description Blank = no change N = Not EGHP Y = EGHP Type 72 transactions: beneficiary Blank = not EGHP Y = EGHP beneficiary Secondary Insurance plan’s ID number for Secondary Insurance plan’s Group ID number for Y = Beneficiary has secondary drug insurance N = Beneficiary does not have secondary drug insurance available Blank – Do not know whether beneficiary has secondary drug insurance Type 72 MA-PD and PDP transactions: Y = Secondary drug insurance available N = No secondary drug insurance available Blank = no change ‘075’ = 75% subsidy level, ‘050’ = 50% subsidy level, ‘025’ = 25% subsidy level, ‘000’ = No subsidy, ‘100’ = 100% subsidy level Type 61 & 71 MA-PD and PDP transactions: Type 60, 61, 71 transactions: Part D low-income premium subsidy category: 6 of 7 03/26/06 198-198 Position 234 - 234 219 – 233 199 – 218 235 – 237 1 1 3 15 20 Size Weekly/Monthly Transaction Reply Field Level Premium Subsidy Insurance Flag 49. Part D Low-Income 45. Secondary Drug 46. Secondary Rx ID 48. EGHP 47. Secondary Rx Group

7 Description ‘5’ = Unknown ‘0’ = none, not low-income ‘1’ = $2/$5 (High) ‘2’ = $1/$3 (Low) ‘3’ = $0 (0) ‘4’ = 15% Calculated Part D late enrollment penalty, not YYYYMMDD. Format: -9999.99 (54). Format: -9999.99 income subsidy. Format: -9999.99 Amount of Part D low-income premium subsidy. including adjustments indicated by items (53) and Format: -9999.99 Date co-pay category became effective, Amount of Part D late enrollment penalty low- Amount of Part D late enrollment penalty waived. Definitions of the co-payment categories: 7 of 7 03/26/06 Position 263 - 270 255 - 262 239 - 246 247 - 254 238 – 238 1 8 8 8 8 271- 278 8 Size Weekly/Monthly Transaction Reply Field Effective Date Amount Amount Penalty Subsidy Amount Penalty Amount Premium Subsidy Penalty Waived 51. Low-Income Co-Pay 55. Low-Income Part D 52. Part D Late Enrollment 54. Part D Late Enrollment Category 50. Low-Income Co-Pay 53. Part D Late Enrollment

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