Notices involving Medicare Part C or Part D require special processing routines. When
a technician needs to complete check paragraphs manually and Part C or Part D entitlement
is involved, the technician will now have to wait until the next day when the MBR
is updated to provide correct payment information for any UTI that requires a payment
amount. In the event of Part C or Part D, the technician will not know the amount
of Part C or Part D that is being deducted from the payment until DED/ADD data is
built and updated to the MBR.
In DED/ADD data on the MBR, the date shown in the data element "UPDATED" will match
the DRD (Debit Run Date) in benefit data. The technician obtains needed information
from the DED/ADD data and completes the notice by matching the DRD with the date shown
in the data element "UPDATED".
In the data element "ITEM” in DED/ADD data, all net checks payable to the beneficiary
are 999 items. All deduction events have their own unique item number. For instance,
Part C arrearages is item 460. Item 455 represents Part C deductions for ongoing monthly
premiums. All addition events also have their own item numbers. The chart below contains
the corresponding FACT query display for Items 445, 450, 455, and 460.
DED/ADD Data Code
|
DED/ADD Data Result
|
PART D MED PREM
(Query Display)
445 (LIMIT Display)
|
Part D Medicare (Current)
|
PART D MED ARR
(Query Display)
450 (LIMIT Display)
|
Part D Medicare Arrearage
|
PART C MED PREM
(Query Display)
455 (LIMIT Display)
|
Part C Medicare Premium (Current)
|
PART C MED ARR
(Query Display)
460 (LIMIT Display)
|
Part C Medicare Arrearage
|
In the data element "TYPE", the MBR will show whether the payment was a PMA, CMA or
MBP. CMA's and MBP's from MADCAP are paid based on the beneficiary's payment cycle.
For PMA's, we add 7 days to the DRD for our notices and use that as the date it will
be paid.
In the data element "SOURCE", the MBR will show the system that was used to generate
the payment (T2, MADCAP, BRI, etc).
EXAMPLE 1 - LIMIT Display
DED/ADD
COM MTH
|
UPDATED
|
TYPE
|
SOURCE
|
AMOUNT
|
START
|
STOP
|
ITEM
|
12/2005
|
12/20/2005
|
PMA
|
MADCAP
|
$300.00
|
|
|
460
|
12/2005
|
12/20/2005
|
PMA
|
MADCAP
|
$1554.00
|
|
|
999
|
12/2005
|
12/20/2005
|
PCMA
|
MADCAP
|
$150.00
|
|
|
455
|
12/2005
|
12/20/2005
|
PCMA
|
MADCAP
|
$263.00
|
|
|
999
|
12/2005
|
12/20/2005
|
MBP
|
MADCAP
|
$150.00
|
|
|
455
|
12/2005
|
12/20/2005
|
MBP
|
MADCAP
|
$263.00
|
|
|
999
|
EXAMPLE 2 FACT Query Display
In the following example:
-
•
an action was taken against the beneficiary in the PE Run of 12/20/2005 (DRD = 12/20/2005)
resulting in PART C entitlement;
-
•
$300.00 was deducted from the PMA payment for a Part C arrearage resulting in a net
PMA of $1554.00;
-
•
$150.00 was withheld from the CMA payment for PART C resulting in a net CMA of $263.00;
and
-
•
$150.00 is also withheld from the ongoing MBP for Part C resulting in an ongoing MBP
of $263.00.
PYMT-MTH 12/2005
|
UPDATED - 12/20/2005
|
SOURCE - MADCAP
|
PYMT-TYPE - PMA
|
AMOUNT - $300.00
|
START
|
STOP
|
ITEM - PART C MED ARR
|
|
|
PYMT-MTH 12/2005
|
UPDATED - 12/20/2005
|
SOURCE - MADCAP
|
PYMT-TYPE - PMA
|
AMOUNT - $1554.00
|
START
|
STOP
|
ITEM - NET AMOUNT ISSUED
|
|
|
PYMT-MTH 12/2005
|
UPDATED - 12/20/2005
|
SOURCE - MADCAP
|
PYMT-TYPE - PCMA
|
AMOUNT - $150.00
|
START
|
STOP
|
ITEM - PART C MED PREM
|
|
|
PYMT-MTH 12/2005
|
UPDATED - 12/20/2005
|
SOURCE - MADCAP
|
PYMT-TYPE - PCMA
|
AMOUNT - $263.00
|
START
|
STOP
|
ITEM - NET AMOUNT ISSUED
|
|
|
PYMT-MTH 12/2005
|
UPDATED - 12/20/2005
|
SOURCE - MADCAP
|
PYMT-TYPE - MBP
|
AMOUNT - $150.00
|
START
|
STOP
|
ITEM - PART C MED PREM
|
|
|
PYMT-MTH 12/2005
|
UPDATED - 12/20/2005
|
SOURCE - MADCAP
|
PYMT-TYPE - MBP
|
AMOUNT - $263.00
|
START
|
STOP
|
ITEM - NET AMOUNT ISSUED
|
|
|