DAILY CUMULATIVE FIRAGING REPORT LAYOUT A Numeric Numeric Numeric Numeric

Transcription

1 Report of report Numeric Plan Year Current Benefit Plan Year Numeric (CCYY) HICN Health Insurance Claim Z 11 Alpha/Numeric Number Transaction ID A unique identifier sent by the Facilitator on all FIR transactions A 21 Alpha/Numeric of the First FIR in the Series First Failed Last Failed First time the series was sent, even if this F could not be sent. First time this FIR was sent and rejected. Last time this FIR was sent and rejected Numeric Numeric Numeric Last Successful of Last Next Scheduled Automated Failed Pre-F Indicator If this is the first time the FIR has failed, this date will equal the First Failed. Last time this FIR succeeded. This field is reported when there was a successful FIR previous to this report. This is the most recent date the series being reported was run. Next time the series being reported on will run. This field will be blank when there is no next scheduled automated transmission date. This indicator is Y when a FIR rejected because of a prior plan. Value: Y = Yes Numeric Numeric Numeric Y 1 Alpha/Numeric 6/12/2014 Page 1 of 6

2 Field Name Definition Example Max Format N = No Fail Age Report generation date minus First Fail Numeric Number of Pre- F s for this Series of last Pre-F Contract Send Count Sequence Send Count Number of Automated Tries Left Displayed as number of days since First Failed. (DD) (Calculated Field) Number of FIR s sent to prior plan for this series where Failed Pre-F Indicator = Y (reject by prior plan) is based upon the First FIR in the series. No leading zeros will be provided. There are zero Pre-F s a zero value will be reported. of last FIR sent to prior plan where prior plan rejected. The number of times this FIR has been sent. The number of times the sequence has been sent. 99 = This is the final FIR reported in the series. No more automated series. The number of remaining FIR transmissions for the series. 2 3 Numeric Numeric 3 3 Numeric 1 3 Numeric 2 3 Numeric Processor Name Contract ID PBP ID The name that RelayHealth has associated with the Bank Identification Number (BIN) The ID assigned by CMS to the health plan when contracted for Part D Medicare Part D Plan Benefit Package ID assigned by CMS for the ABC Health 50 Alpha/Numeric A Alpha/Numeric Alpha/Numeric 6/12/2014 Page 2 of 6

3 Plan Benefit Package BIN The Bank Identification Numeric Number (BIN) is the identifier number for the payer. PCN Processor Control Number bb 10 Alpha/Numeric is the identifier number for the processor. Group ID Plan group identifier Alpha/Numeric assigned by plan Cardholder ID Beneficiary identifier Alpha/Numeric assigned by plan of Birth Beneficiary date of birth Numeric Reject Code NCPDP reject reason code 04 4 Alpha/Numeric Reject Definition of the Reject M/I Processor 100 Alpha/Numeric Description Code Control Number Transaction The type of FIR transaction F1 2 Alpha/Numeric Type (F1, F2, or F3) LIS Indicator This indicator is Y when a Y 1 Alpha/Numeric beneficiary has Low Income Subsidy effective coverage. This information is valid as of the date and delivery of the report. Value: Y = Yes N = No Non-Plan of Record A=Audit-off (Indicates Contract ID is a current non plan of record for the beneficiary) (Automated from CMS Eligibility File) P 1 Alpha/Numeric Non-Plan of Record Effective P=Proxy Add (Indicates Contract ID is a current non plan of record for the beneficiary) (Manual Request or POS-FE Add) The effective date of the Non-Plan of Record. This field is reported when the Non-Plan of Record field is equal to A Numeric 6/12/2014 Page 3 of 6

4 Non-Plan of Record Termination The termination date of the Non-Plan of Record Numeric This date reflects the received date of the automated eligibility change received by the Transaction Facilitator. However, plans may pay for additional days past this period and need to ensure that the plan report these days. Plan Of Record Contract ID 1 Contract ID 2 Contract ID 3 This field is reported when the Non-Plan of Record field is equal to A. Plan of Record (POR), which means the plan was listed in the most recent update from CMS (not necessarily the current active plan). Identifies whether entity receiving the report is Plan of Record or not. Values: Y = Yes N = No The first Contract ID in the The second Contract ID in The third Contract ID in the Y 1 Alpha/Numeric A Alpha/Numeric B Alpha/Numeric C Alpha/Numeric 6/12/2014 Page 4 of 6

5 Contract ID 4 The fourth Contract ID in C Alpha/Numeric Contract ID 5 The fifth Contract ID in the C Alpha/Numeric Contract ID 6 The sixth Contract ID in the C Alpha/Numeric Contract ID 7 The seventh Contract ID in C Alpha/Numeric Contract ID 8 The eighth Contract ID in C Alpha/Numeric Contract ID 9 The ninth Contract ID in C Alpha/Numeric Contract ID 10 The tenth Contract ID in C Alpha/Numeric Contract ID 11 The eleventh Contract ID in C Alpha/Numeric Contract ID 12 The twelfth Contract ID in C Alpha/Numeric Contract ID 13 The thirteenth Contract ID C Alpha/Numeric 6/12/2014 Page 5 of 6

6 in the send order of the Plans Contract ID 14 The fourteenth Contract ID C Alpha/Numeric in the send order of the Plans Contract ID 15 The fifteenth Contract ID in C Alpha/Numeric Contract ID 16 The sixteenth Contract ID C Alpha/Numeric in the send order of the Plans Gender The gender code of the beneficiary associated with the Part D Plan Eligibility provided by CMS 1 2 Numeric 6/12/2014 Page 6 of 6